Gamma knife tremor patient comes back to get the other side done!

Our first tremor patient treated with gamma knife radiosurgery recently came back, one year later, to have the other side treated.
He has essential tremor, which was affecting both arms.
He had undergone treatment to the left brain for right sided tremor last year.
He was so pleased with his results, he recently came to have the right brain treated to address the left sided tremor.
Here is his most recent video.
Note the action and postural tremor on the left (untreated) side, and the fact that he has almost not residual tremor on the right (treated) side.

Click here to find out more about Gamma knife radiosurgery for tremor at the Monmouth Neuroscience Institute.

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Monmouth’s Facial Pain Center on CBS News!

Click here to find out more about one of the patients featured in this story.

Find out more about headache and facial pain, and treatment options for trigeminal neuralgia, including surgical treatment.

Come to one of our trigeminal neuralgia support group meetings – check the Neuroscience Events Panel on the right side of the page.

Tremor Patient Markedly Improved 6-months After Gamma Knife Radiosurgery

This 73-year-old left-handed man had complained of progressively worsening tremor for more than 25 years.    He had become unable to write or (actually more of a concern to him) use chop sticks.

He was evaluated in the multidisciplinary tremor clinic at Monmouth Neuroscience Institute in March 2013.  We determined that he had already failed to respond to, or had side effects from, the oral medications usually used to treat tremor.  He was not a good candidate for deep brain stimulation because of previous bran surgery and cognitive impairment.

He  underwent gamma knife radiosurgery to the R thalamus in April 2013.  There were no side effects.

He started to see significant improvement in L sided tremor during the fall of 2013, and by October was able to use chop sticks again!

Click here to find out more about the program.
Click here for contact information.

Stereotactic radiosurgery for obsessive compulsive disorder, Phineas Gage meets the Jetsons.

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Small studies have shown that gamma knife stereotactic radiosurgery can relieve symptoms in as many as 50% of patients with obsessive-compulsive disorder (OCD) who got no help from conventional behavioral or medical therapies.

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What is OCD?

OCD is an anxiety disorder in which people have unwanted and repeated fearful thoughts (obsessions) that drive them to perform repeated behaviors (compulsions) to temporarily relieve the associated anxiety.

Examples of OCD include excessive hand washing or cleaning, repeated checking and nervous obsessive rituals like such as opening and closing a door a certain number of times before entering or leaving a room.

Anxiety from OCD and the resultant obsessive ritualistic behaviors can be alienating and time-consuming, leading to emotional and financial distress.

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Symptoms of OCD can be ameliorated by medications, such as serotonin reuptake inhibitors, and behavioral therapy.  However, many severely affected patients remain unable to function normally despite these interventions, leading them to look for more effective or permanent solutions to this difficult problem.

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Surgery for psychiatric disorders.

Phineas Gage (1923-1960) survived an accident in which a pole impaled his head going through his left cheek, destroying his eye, through the frontal part of his brain, and back out the right top part of his skull.
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Before the accident, he was described by his friends as a friendly, calm, caring man.  After the accident, he became bad mannered, aggressive, foul-mouthed, and anti-social to the point where he could no longer hold a job and none of his friends wanted to associate with him anymore.

His skull was saved and later analyzed to plot the trajectory of this pole through his skull, finding that the rod mostly damaged the middle region of the frontal lobes.

This and other cases of medial frontal lobe lesions causing similar changes in behavior led to the conclusion that this part of the brain’s function is related to normal social  social behavior

Surgical frontal lobotomy was first performed in the 1935, and lobotomized patients showed a decrease in agitation, anxiety, and depression.  Walter Freeman and James Watts spread the technique of lobotomy across America in the 1930 and 40s, and it became considered as a quick fix for dealing with overcrowded insane asylums.

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Ultimately the procedure was conducted using an “ice pick” inserted into the frontal lobe through the orbit under a brief period of unresponsiveness induced by ECT.

However, with the advent of psychotherapeutic drugs and increasing evidence for the horrors and limited therapeutic effects of lobotomy, the surgery lost popularity, almost becoming completely extinct.

Nevertheless, the important influence of the frontal lobes on social behavior was not forgotten, and more recent PET studies have further reinforced the influence of this brain region area in OCD:

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PET study showing increased activity in the frontal lobes in a OCD patient compared to a normal control.

There has been a limited comeback of psychosurgery, initially the form of less invasive non destructive  surgical techniques like the anterior cingulotomy (designed just to sever the connections between the frontal lobes and the underlying subcortical structures) still used for patients with severe OCD and depression refractory to conventional therapies.

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Gamma knife for OCD.

Activated deep brain stimulation electrodes placed into the anterior limb of the internal capsule can also interrupt the circuits than connect the frontal lobes to the rest of the brain and ameliorate OCD behavior:

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Gamma knife radiosurgery can create permanent lesions in these same regions of the brain, leading to Permanent lesions resulting in long-lasting benefit to OCD patients without the need for implanted hardware.

A recent study published in Neurosurgery by Kondziolka et al (click here for link) demonstrated the long-term benefit of bilateral gamma knife lesioning to the internal capsule in three patients with OCD intractable to conventional medical therapies.

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Gamma knife radiosurgery for OCD. Left – MRI showing the lesions resulting from the procedure. Right – clinical improvement in na OCD rating score in all three patients after surgery (lower score = better).

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Where can you get help and more information?

The International OCD Foundation has a website with more information on medical therapies, psychosurgery, DBS and gammaknife radiosurgery for OCD.

Surgical options for trigeminal neuralgia

Trigeminal Neuralgia

Trigeminal neuralgia is characterized by recurrent short episodes of one-sided zapping, shooting, or excruciating spasms of facial pain. The pain may be so severe that the patient may cry out or visibly wince. The affected area of the face may become super-sensitive, with such minor stimulation as a light breeze, cold temperature, water from a shower, washing the face, shaving, or even eating can set off attacks of pain.

Medical Treatment of Trigeminal Neuralgia
The anticonvulsant carbamazepine is usually first line treatment.
Second line medications include baclofen, lamotrigine, oxcarbazepine, phenytoin, gabapentin, pregabalin, and antidepressants such as amitriptyline.
However these medications are not always effective and can cause side effects such as confusion and unsteady gait.

Surgical Treatment of Trigeminal Neuralgia
Surgical treatment, known as microvascular decompression, involves sub occipital craniotomy, mobilizing the offending blood vessel off the nerve, and insertion of a sponge to separate these structures.

Partial lesioning of the trigeminal nerve, either by radiofrequency ablation using a percutaneous needle or gamma knife radiosurgery is less invasive and can also be very effective:

Gamma knife for trigeminal neuralgia patient story:
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Non-invasive alternative to brain surgery for tremor.

Essential tremor is a common problem affecting up to 4 percent of Americans, usually affects the hands during motor activities like writing, eating and typing, and can range in severity from mildly annoying to totally disabling.

Currently available medical treatments have limited effectiveness and can cause side effects. Surgical treatment with implantation of a deep brain stimulator can effectively control this type of tremor, but involves a brain operation, and may not be an option for elderly patients with medical problems or those taking blood thinners.

At Monmouth Medical Center’s Gamma Knife Center, physicians are using Stereotactic radiosurgery to deliver a non-invasive, powerful, highly focused gamma radiation beam offering the same beneficial effect without surgery or risk of bleeding or infection.

Gamma Knife is an advanced radiosurgery system that delivers high-dose gamma radiation beams with pinpoint accuracy to targeted locations in the brain. The Neuroscience Institute at Monmouth Medical Center is excited to offer this innovative treatment to patients with disabling intractable tremor, according to neurologist Neil R. Holland, M.D., medical director of the institute.

“We offer a unique and totally multidisciplinary approach to the management of this challenging problem,” Dr. Holland says. “Patients are seen by a neurologist, neurosurgeon and radiation oncologist on the same day, and if they are felt to be candidates, can leave the hospital with an appointment arranged for the Gamma Knife procedure.”

The Gamma Knife Center at Monmouth Medical Center recently celebrated its first year of treating patients. The addition of Gamma Knife technology to the hospital’s radiosurgery program helped place Monmouth Medical Center at the forefront of advanced benign and malignant brain tumor treatment, as well as treatment of functional brain disorders and vascular malformations.

Click here for more information about tremor.  To schedule an appointment with the Gamma Knife Center, call 732-923-6562, or leave a comment!