In a new episode of the Movers and Shakers podcast, listeners are treated to an engaging conversation with Professor Ludvic Zrinzo, Clinical Lead of the UCL Functional neurosurgery Unit. Known for his expertise in functional neurosurgery, Professor Zrinzo shares his insights on the use of focused ultrasound (FUS) technology and its transformative potential in treating movement disorders, especially essential tremor and Tremor-Dominant Parkinson’s Disease. The episode offers a detailed exploration of this incisionless procedure, the pros and cons, and the future of brain treatments:

Introduction to Professor Ludvic Zrinzo

Professor Ludvic Zrinzo is a renowned neurosurgeon and the Clinical and Academic Head of the UCL Functional Neurosurgery Unit. With a strong background in clinical neuroscience, Professor Zrinzo has dedicated his career to improving the surgical care of patients with chronic neurological and psychiatric diseases. His expertise spans deep brain stimulation, stereotactic ablation, and microvascular decompression procedures, making him a leading figure in the field of functional neurosurgery. His work at the UCL Functional Neurosurgery Unit has been pivotal in advancing treatment options and improving patient outcomes.

What is Focused Ultrasound in Functional Neurosurgery?

Professor Zrinzo introduces focused ultrasound (FUS) as a ground-breaking treatment that combines high-quality MRI imaging with the power of ultrasound. He explains how FUS allows surgeons to visualize the brain in intricate detail and precisely target the specific area responsible for tremors. By using ultrasound to create a small “burn” or lesion, surgeons can alter the faulty brain circuits that cause these tremors. This non-invasive approach is revolutionizing the way conditions like essential tremor and Parkinson’s tremor are treated.

The Pros and Cons of Focused Ultrasound

A major advantage of FUS, Professor Zrinzo explains, is that it doesn’t require incisions—no scalpel is needed. It’s an incisionless procedure, which reduces risks associated with traditional surgery. As the interviewers recognised, many patients may be disconcerted by the idea of deliberately creating a permanent lesion in the brain. However, Professor Zrinzo likens it to “burning away” an unwanted skin lesion. Just like a simple surgical procedure may be used to remove an unwanted mole or skin lesion, the FUS procedure creates a small, targeted lesion in a misbehaving brain circuit to alleviate a patient’s symptoms. However, he stresses the importance of having the right tool in the right hands, as the success of FUS, like any surgery, depends heavily on the surgeon’s skill and precision.

Witnessing a Procedure: The ‘Mission Control’ Treatment Room

In a vivid moment of the podcast, co-host Rory Cellan-Jones recounts his experience of watching a focused ultrasound procedure in action. He describes the treatment room as something like a “mission control” centre. He witnessed first-hand the precision and coordination required as the medical team monitored the patient in real-time, performing tests throughout the procedure to assess the treatment’s effectiveness before making the final permanent lesion.

Who is the Treatment For?

Professor Zrinzo highlights that focused ultrasound was initially developed for patients with essential tremor, a condition where the circuits to be targeted are well-defined and can be clearly visualised using MRI. However, he explains that FUS is now being explored for treating Parkinson’s tremor, though the challenge with Parkinson’s is that tremor is often just one of several motor symptoms. In Queen Square, our aim is to lead research to investigate how FUS can be used to target different areas of the thalamus to address a broader range of Parkinson’s symptoms—a promising focus for future research.

Is Focused Ultrasound Superior to Deep Brain Stimulation?

One of the burning questions raised during the episode is whether FUS is superior to deep brain stimulation (DBS), a well-established treatment for tremor. Professor Zrinzo explains that both procedures have their place. FUS has the advantage of being incisionless, with no wires or stimulators implanted, which some patients may prefer. However, the ability to offer both treatments allows surgeons to tailor the best option for each patient’s needs. This flexibility in treatment choice is, for Professor Zrinzo, one of the most exciting developments in functional neurosurgery.

Can You Have Treatment on Both Sides of the Brain?

At present, there is still limited understanding of the side effects of treating both sides of the brain with FUS at the same time. Professor Zrinzo notes that, while simultaneous treatment is not advisable, the old belief that staggered second treatments were impossible is no longer valid. Staged second side treatment is now approved, and advances in research may pave the way for future possibilities in this area.

The Use of Gamma Knife for Tremor Treatment

The episode also touches on Gamma Knife, another technique sometimes used to treat tremor in Queen Square. Professor Zrinzo explains that while Gamma Knife can be effective, it lacks the immediate feedback that focused ultrasound or DBS provides, as the brain’s response to radiation is delayed. This difference makes FUS or DBS more appealing for patients who want immediate symptom relief.

How Do We Know Where to Target in functional neurosurgery?

Queen Square has long used advanced MRI technology to identify precise targets in the brain for treatment, and this experience has made them leaders in the field of targeted brain lesioning for functional neurosurgery, like FUS. Professor Zrinzo emphasizes the importance of accurate targeting in the brain, as the success of both FUS and DBS depends on hitting the correct circuits responsible for symptoms.

Patient Story: Ian King’s Journey with Focused Ultrasound

To bring the technology’s real-world impact into focus, the podcast features the story of Ian King, a patient who underwent FUS a few months prior at the Queen Square Imaging Centre. Mr. King had suffered from a debilitating tremor in his right hand and leg, which had severely impacted his quality of life. Embarrassment and functional disability made going out or pursuing his love of golf impossible. Despite initial apprehension, the procedure was a success. After 2 hours of testing and treatment, he was immediately able to once again perform simple tasks like holding a glass of water without spilling—a moment that changed his life. Today, his tremor is gone, and he enjoys a renewed sense of freedom, even getting back to his golf game. He humorously shares that now he has no excuses for his putting!

This episode of Movers and Shakers offers a comprehensive look at the latest promising tool for the treatment of tremor through the lens of focused ultrasound. Professor Ludvic Zrinzo’s expertise and passion for advancing treatment options come through as he discusses the evolution of FUS, its potential for treating complex neurological conditions, and the exciting progress being made in Queen Square. At the end of the interview, the interviewers discuss the ultimate question – whether they would be keen on having focused ultrasound treatment. For Gillian Lacey-Solymar and Paul Mayhew-Archer, the question is academic, since they have already had DBS and would no longer be eligible for FUS. However, the rest were excited about what the treatment could achieve for them. For listeners curious about the future of medicine and the cutting-edge technology that is transforming lives, this episode is a must-listen.

This podcast episode (‘Targeted Ultrasound’ published 28/09/2024) is available via the podcast website here, or from wherever you normally get your podcasts. You may also be interested in Rory Cellan-Jones’ blog, written to accompany the episode.

If you or someone you know would be interested in more information about the Queen Square focused ultrasound service, contact our treatment coordinators at treatment@queensquare.com.