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Artist’s tremor reversed with no-cut brain surgery at OHSU

OHSU is the first hospital in the state to use cutting-edge surgery to treat essential tremor, without requiring any actual cutting.

PORTLAND, Ore. — A revolutionary no-cut brain surgery is changing lives for patients suffering from tremors. Yes, that means brain surgery without an incision, without going under, delivering immediate results.

Carolyn Wilhelm, an artist from Trout Lake, has suffered from tremors for about 30 years. She arrived at Oregon Health & Science University along Portland’s South Waterfront early one morning with her husband. Her hair was already cut in preparation for the surgery ahead.

“I’m feeling really hopeful,” she said.

She wasn't headed to the operating room, however. She was bound for the MRI room, about to undergo a cutting-edge brain surgery procedure where there’s no cutting at all.

A medical breakthrough

“It’s a very effective operation. With careful targeting, almost everyone sees a tremor reduction or complete cessation of tremor, the tremors disappear, the use of the hand improves,” Dr. Ahmad Raslan said. “The whole thing takes about an hour, an hour and a half.”

Dr. Raslan is the OHSU neurosurgeon leading the new program. He believes this type of focused ultrasound technology will be used more and more. It has the potential to help millions suffering from essential tremor and tremor-dominant Parkinson’s disease.  

Essential tremor, or familial tremor, is a debilitating, progressive neurological condition. Trembling, most often in the hands, makes daily tasks difficult, sometimes impossible.

“I can’t even like scoop spaghetti sauce onto spaghetti or eat without getting embarrassingly all over everything,” Wilhelm said.

Wilhelm, a professional artist, has seen her tremor progress over the decades, but it has gotten much worse over the past couple of years, she said.

“Lots and lots of things you wouldn’t even think of are impacted by not being able to hold my hand steady, but most of all the art making,” Wilhelm said.

While she’s never stopped following her passion, he’s had to adapt. She uses the assistance of an iPad to make her art now.

“I haven’t been able to paint or really draw without the computer for a couple years,” she said.

This surgery offers her a chance to take back control.

“We understand, through many years of research, we know the circuits of the brain. And we know that this particular circuit of the brain is abnormal in certain people,” said OHSU Fellow and Instructor of Neurological Surgery Dr. Daniel Cleary. “It’s a circuit that coordinates activity. Normally, it does a good job by giving feedback and coordinating the activity for smooth motion, but in some people, as they get older that circuit goes awry and it gives too much feedback. When they’re trying to do a smooth motion, it overcorrects, and it overcorrects more and more and more.”  

Essential tremor can get worse over the years, and in many patients medications don’t work well.

“In those cases, what we can do is; we can go through and ablate, or burn, this tiny little circuit, just one tiny little part of it, and that corrects it,” Dr. Cleary said. “So, instead of doing this overcorrection, it becomes smooth again.”

The procedure offers instantaneous, life-changing results, with less recovery time than invasive surgery.

“Then they go home after this and all of a sudden, they can feed themselves again, they can do all their normal activities again. So, pretty amazing treatment,” Dr. Cleary said.

“I hope the hardest part was having my hair cut off yesterday,” Wilhelm said as she waited for her final procedure prep.  

The surgery required Wilhelm to cut and then shave off her long locks.

“That was very teary for me because that was my identity, I think,” she said.

The support of friends helped ease that step, however. They threw her a hair-cutting party the night before. Wilhelm had enough length to be able to donate her hair to Hair We Share, to be made into wigs for cancer patients.

Under the knife, minus the knife

The OHSU team examined the severity of Wilhelm’s tremor, looking at her handwriting and using what they call a "cup test." She holds a cup close to her chest and then out straight, then back again toward her and to her mouth.

As Wilhelm did both tests for the doctors, her tremor was pronounced. She trembled moving the cup. Writing her name was difficult. She drew spirals on a test sheet but could not stay within the lines.

After some encouragement from her husband, Wilhelm was brought to the MRI.

“We harness the power of sound using about 1,024 sound beams into one focal point," Dr. Raslan said, “and that one focal point is the area of the brain that’s dysfunctional.”

The team pinpointed the dysfunctional circuit in the brain, using guided MRI. They then used directed sonic beams to ablate that dysfunctional circuit in the brain that’s been causing the tremor.

The results happen in real time.

The team went back into the MRI room where Wilhelm waited to test the results. Dr. Raslan handed her another cup. It was time for the moment of truth — a repeat of the “cup test.”  

Still lying on the MRI table, Wilhelm pushed her arm forward. It was steady. The cup in her hand barely moved. The tremor that had afflicted her for more than three decades, that changed the way she made art, had nearly vanished.

It wasn't until Wilhelm was back in the recovery room that the results started to set in for her.

“Astonished really,” she said.

Wilhelm was handed a glass of water and took a sip.

“Are you seeing this, it’s amazing!” a nurse exclaimed

“I didn’t spill it all over myself,” Wilhelm laughed. “I could not do that before."

Dr. Raslan said that for decades this surgery was invasive, requiring anesthesia, drilling and cutting into the skull. This procedure is a game-changer.

“Patients could get a very complex operation, delicate, and yet can go home the same day. And this is by just changing the whole concept of surgery, in which surgery can be done without causing the incision,” he said. “That’s a huge advance in science and in medicine in general and we’ll see a lot more of this. I’m very excited that we have this in our hands now.”

After only a few hours at the OHSU Center for Health and Healing, Wilhelm and her husband got to leave — onto a new chapter, not only for Wilhelm’s art but for her entire life.

“There are little things that, I haven’t been able to do, that I couldn’t even tell you until all of sudden I’ll be able to do them again,” Wilhelm said. “They just burn a little bit, and then I have my hand back.”

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