Mike Mattozzi was just a teen when he noticed a shaking sensation in his right (dominant) hand. It was mild at first but grew more severe over the years. Later, he went through the same thing with his left hand.
As time passed, Mike's quality of life suffered due to the tremor. Using a pen, steak knife, or screwdriver became nearly impossible. Worse yet, the condition was affecting his work as a salesperson in the software industry.
"I'd sit down with someone on a sales call, and my hands would be shaking," he said. "What's the other person thinking? That I'm nervous because I'm lying or hiding something from them."
Mike, who lived in New Hampshire at the time, was finally diagnosed with essential tremor at age 37. This is a common movement disorder that causes uncontrollable shaking. Symptoms typically begin in the dominant hand before moving to the other hand. They can also affect the legs, head, and voice.
At age 65, Mike had a procedure done at Brigham and Women's Hospital called magnetic resonance imaging (MRI) focused ultrasound to address his symptoms. The results have been nothing short of remarkable.
Focused ultrasound seen as the right fit
Years after Mike was diagnosed with essential tremor, a local neurologist prescribed a medication. It helped at first but became less effective over time. The neurologist then switched him to a different medication.
Concerned about possible side effects, Mike's primary care doctor recommended exploring other treatment options. She referred him to neurosurgeon G. Rees Cosgrove, MD, FRCSC, director of functional neurosurgery at Mass General Brigham.
By that point, Mike's symptoms had progressed significantly. "I'd pour a cup of coffee and spill some on the counter. Then I'd walk to the other room and leave a trail of coffee behind me," he said. "When I went out for dinner, the food would fall off my fork. It was embarrassing. I worried about how other people perceived me."
Dr. Cosgrove said that since the medications had outlived their usefulness, one treatment option was deep brain stimulation (DBS). This involves implanting a device deep inside the brain. Electrodes on the device send safe pulses of electricity to areas of the brain responsible for tremor symptoms.
However, some people prefer not to have an invasive procedure or a medical device put in their brain. For these patients, focused ultrasound might be a better fit.
This was the case for Mike. His focused ultrasound procedure was scheduled to treat the tremor in his right hand.
No incision or anesthesia required
Early pivotal research into focused ultrasound took place at Brigham and Women's in the 1980s. Dr. Cosgrove was the first surgeon in New England to perform the procedure.
Prior to focused ultrasound, the patient's head is shaved and a special frame is placed around the head to prevent movement. As the patient lies inside an MRI machine, hundreds of tiny, highly focused sound waves are directed to a specific area of the brain. The sound waves produce heat to destroy the brain tissue causing tremors. Using MRI allows the surgeon to identify and target the tissue with great precision and to confirm the treatment's effectiveness.
Focused ultrasound requires no incision or anesthesia. The procedure usually involves two to four treatment cycles, each lasting about 15 to 20 seconds, and takes a total of two to three hours. Most patients experience no more than a brief headache.
"I call it 'no-touch brain surgery,'" Dr. Cosgrove said. "And it's done on an outpatient basis. The patient comes into the hospital, gets the procedure, and goes home after a brief stay in the recovery room. How often does brain surgery look like that?"
Physician assistant Sarah Christie, PA-C, assists Dr. Cosgrove with both procedures and patient consultations before and afterwards. Harvard Medical School professor of radiology Nathan McDonnald, PhD, who played a critical role in the development of focused ultrasound three decades ago, also assists with most procedures.
Dr. Cosgrove noted that he and his team's deep familiarity with focused ultrasound and DBS is a critical advantage.
"You have to be an expert in both to determine which is more appropriate for each patient," he said. "The best outcomes in focused ultrasound are achieved by neurosurgeons who are trained in functional neurosurgery. Our team has vast and growing experience, and we remain one of the busiest centers in the United States."
