{"id":76768,"date":"2024-07-18T05:14:15","date_gmt":"2024-07-18T11:14:15","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/?p=76768"},"modified":"2024-07-18T05:14:15","modified_gmt":"2024-07-18T11:14:15","slug":"new-treatment-for-essential-tremors-brings-decades-of-shaking-to-an-end","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/new-treatment-for-essential-tremors-brings-decades-of-shaking-to-an-end\/","title":{"rendered":"New treatment for essential tremors brings decades of shaking to an end"},"content":{"rendered":"
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\"Kathleen
Kathleen Ruth-Tepper loves spending time with her granddaughter and finds it much easier to do everything now that she no longer has to deal with bad tremors. Photo courtesy of Kathleen Ruth-Tepper.<\/figcaption><\/figure>\n

Her husband calls Kathleen Ruth-Tepper a hard-headed woman.<\/p>\n

And he means that figuratively and literally, as her determination finally led her to a solution for the tremors that caused her hands to shake so severely, she could no longer cook, sew, play the piano, button a blouse or put on earrings.<\/p>\n

The fact that her skull was a specific thickness made it possible for the innovative treatment she received at UCHealth which used high-intensity focused ultrasounds (HiFU) targeted at specific parts of her brain causing her tremors.<\/p>\n

\u201cFortunately for me, the test I had to undergo before the procedure showed I have a very hard skull. Yay!\u201d Kathleen said with a laugh and then looked at her hands<\/p>\n

\u201cThis is so important! I can sew buttons; I even threaded the needle. I can garden. I can do crafts with my grandchild, and I\u2019ve got more energy to spend with her.\u201d<\/p>\n

Bill, her husband of 20 years and a retired home builder and developer, agreed: \u201cShe\u2019s almost a different person now.\u201d<\/p>\n

A Denver native, Kathleen, now 73, has dealt with tremors since she was a teen.<\/p>\n

\u201cI knew I had it. My mother had it, my grandfather and great-grandfather had it. They used to call it \u2018familial tremors.\u2019\u201d<\/p>\n

What Kathleen and her family members suffered from was essential tremors, a neurological condition that causes hands to shake, usually one worse than the other. It can also affect other body parts such as the head and voice. For more than half of the people who have it, the cause is genetic and is inherited from a parent. For the other half, the cause is unknown, though stress and anxiety can increase tremor frequency.<\/p>\n

\"Kathleen,
Kathleen, with her husband, Bill. He encouraged her to get surgery to help with her tremors. Her “hard head” made the surgery possible. And her persistence helped her find a treatment for lifelong essential tremors. Photo courtesy of Kathleen Ruth-Tepper.<\/figcaption><\/figure>\n

Kathleen\u2019s adult son also experiences minor essential tremors \u2013 another crucial factor that pushed her to find a cure so she could give him hope for his own condition. She has another reason to get her tremors under control: Bill has been diagnosed with Parkinson\u2019s disease, and it is important she is able to assist him if his condition deteriorates. She also has three grandchildren, including a very active 6-year-old, who likes to play a lot.<\/p>\n

Essential tremors begin to affect her quality of life<\/strong><\/h2>\n

As she got older, Kathleen grew accustomed to her shaking hands and kept them out of sight when possible: in her lap or by her side. One hand, her left, shook more than her right.<\/p>\n

\u201cShe was good at hiding it,\u201d Bill said.<\/p>\n

She gradually realized the tremors were becoming more noticeable. For instance, while living in Oklahoma and working in a job that required public presentations, the notes in her hand would shake during her speeches.<\/p>\n

\u201cI would think, \u2018This isn\u2019t good, they think I\u2019m nervous, but I\u2019m not.\u2019\u2019\u2019<\/p>\n

As the years passed, the shaking got worse and harder to conceal. She compensated with elaborate techniques to complete daily routines, such as holding a nail polish bottle with both hands and carefully bringing the brush to each finger with two hands.<\/p>\n

When one nail polish episode ended with her inadvertently throwing the nail brush across the room, she faced up to how serious her condition had become.<\/p>\n

\u201cI thought, \u2018That\u2019s it. I\u2019m done with this.\u2019\u2019\u2019<\/p>\n

More activities started to fall by the wayside as the effort to complete them became too difficult. Kathleen and Bill recalled that a trip to a restaurant might involve her food flying onto someone else\u2019s plate \u2013 or face \u2013 as she attempted to bring the fork to her mouth.<\/p>\n

\u201cShe\u2019s always kept her sense of humor about this,\u201d Bill said with a smile, as they both laughed.<\/p>\n

But her optimistic and can-do attitude belied the despair she was beginning to feel. She had always been outgoing and an extrovert, but that was changing.<\/p>\n

Her emotional and psychological health suffered, with the tremors taking a greater physical toll as she could feel them throughout her entire body.<\/p>\n

\u201cI was exhausted,\u201d she said.<\/p>\n

They were beginning to affect her vocal cords, altering the sound of her voice, and making it more difficult for her to be understood. The tremors were also causing spasms in her throat, and she was choking on food. Bill even had to perform the Heimlich maneuver when a piece of apple got stuck in her throat.<\/p>\n

\u201cBill and I are happy together. I have a good life. But there was a part of me that was miserable. I was withdrawn. I never wanted to leave home. When I went to bed at night, I was so tired. The tremors were exhausting, in both hands and in my jaw. I was totally embarrassed. I think I was depressed.\u201d<\/p>\n

The latest treatment for essential tremors: learning about ground-breaking HiFU<\/strong><\/h2>\n

Determination is one of Kathleen\u2019s traits. Strength is another. In addition to dealing with her tremors, she has overcome traumatic brain injuries from two auto accidents, one dating back 28 years ago.<\/p>\n

She also battled back from a severe case of sepsis caused by a kidney stone infection in 2017. The ordeal left her in a hospital intensive care unit for 40 days where she was on a respirator, followed by a month in an acute rehab facility where she had to re-learn how to swallow, sit, stand and walk. The tracheotomy and necessity for intubation during her illness exacerbated her hand and speech tremors.<\/p>\n

\u201cI\u2019ve been tested. I\u2019ve been challenged,\u201d she said.<\/p>\n

Before seeking help at UCHealth this spring, she was on various medications to control her tremors and had seen numerous providers as she searched for answers. Eventually, she was told she had Parkinson\u2019s disease, (a very different disease as opposed to essential tremors), characterized by insidious onset of rest tremor, slowness of movement and impairment of gait. It is not uncommon for patients like Kathleen to be misdiagnosed.<\/p>\n

Further investigation led her to the diagnosis of essential tremors. Medications were not resulting in an improvement in her everyday life, and she was referred to the University of Colorado Advanced Therapies in Movement Disorders<\/a> on the Anschutz Medical Campus<\/a>.<\/p>\n

The specialized team there consists of many experts, all working together to provide cutting-edge treatment for movement disorders, including tremors.<\/p>\n

After much discussion, Kathleen and the team determined that HiFU was a great option for her. With HiFU, a small area deep inside the brain that regulates movement is targeted through high-frequency ultrasound while the patient is awake in an MRI scanner.<\/p>\n

The surgery involves an incision and an overnight stay, and results in at least a 70 percent immediate tremor improvement for patients.<\/p>\n

UCHealth began treating patients with HiFU in 2020, but the procedure went on hiatus as medical experts prioritized treating patients during the COVID-19 pandemic. Surgeries began again last year when 23 patients successfully underwent the treatment, and the department has the capacity to annually help about 50 patients.<\/p>\n

\u201cThe image-guided treatment we are using is fascinating,\u201d said Mari Kelley, a UCHealth registered nurse and movement disorders navigator. \u201cThe patients come in with tremors at their all-time worst, as we ask them to not take their medications before the procedure, and they leave with a near-steady hand. It\u2019s remarkable.\u201d<\/p>\n

Patients seeking help have tremors in their voice and head, but the majority have tremors in both hands, Kelley said.<\/p>\n

The first step toward HiFU eligibility is a full neurological workup to determine an essential tremor diagnosis. If that is established, a patient is asked whether they have optimized other options, such as medication and physical and occupational therapies. If patients still feel that their tremors are not under control after exhausting these methods, they can continue with treatment consideration.<\/p>\n

Tough decisions as Kathleen opted for treatment for essential tremors<\/strong><\/h2>\n

For Kathleen and others, that means a CT brain scan to calculate skull density ratio (SDR). This is critical, as a patient must have an SDR of 0.4 or higher. Skull thickness plays an important role in how successful the ultrasound will be in destroying targeted brain cells causing the tremors, and creating lesions in their place so they don\u2019t grow back. Kelley explained that the denser the skull, the more effective ultrasound waves can go through it. The result is a permanent lesion in the region of the brain causing the tremors.<\/p>\n

About 80 percent of essential tremor patients meet this criterion, she said. Once a UCHealth care team determines they are good candidates, they must get a high-intensity MRI a few weeks ahead of the surgery to map the targeted site in the brain.<\/p>\n

UCHealth is one of only five institutions in the country that take the extra step of using MRI tractography to specifically identify the affected brain cells, Kelley said. This includes 3D-modeling and imaging to visually represent the area of the brain that will be targeted with the ultrasound beams.<\/p>\n

\u201cWe map out where we want to put the lesions and where we want to stay away from. That is why we are so successful at what we do,\u201d Kelley said. \u201cWe are getting our targets exactly where we want to get them.\u201d<\/p>\n

With the brain mapping complete and the patient ready, the half-day procedure can commence. What does that mean for patients like Kathleen immediately before the procedure?<\/p>\n