Published: December 24, 2024
In life, day-to-day tasks often are taken for granted.
Brushing your teeth, pouring coffee, lifting food to your mouth — things millions of people do each day without a second thought. But for many who live with essential tremor, simple tasks like these can become impossible. The constant, uncontrollable body tremors can be embarrassing, frustrating and exasperating.
For as long as they can remember, Patrick Murphy and Bob Bender lived this struggle daily.
“As time has gone on, it’s become very obvious,” Patrick said. “I am constantly self-conscious about how [noticeable] it was. And then as soon as I think about it, it gets 10 times worse. You worry about people thinking, ‘What’s wrong with this guy?’ So it kind of builds on itself.”
The experience has been similar for Bob.“It’s gotten so bad in the past year, that it’s become unbearable,” Bob said. “I will literally go some places and keep my hands in my pockets so people can’t see it. [I wonder if] people ask, ‘Is he going through detox? Is he on drugs?’ I mean, I think about that … I really do.”
After years of this struggle, Patrick and Bob finally found relief at Norton Neuroscience Institute, in the form of a new, incisionless brain surgery that relieved their tremor symptoms in a matter of hours.
On Nov. 13, 2024, Patrick and Bob were the first two people in the state of Kentucky to undergo high-intensity focused ultrasound treatment, sometimes called HiFU, for their tremors.
Patrick knew as a child that essential tremor was going to be an inevitable part of his future.
The disorder runs in his family, affecting Patrick, his father, brother, nephew and daughter.
“I remember watching my dad,” he said. “We used to work on cars together when we were younger. He would get way more frustrated than I do. But I can remember a lot of cuss words and throwing tools. It just makes you mad.”
Patrick officially was diagnosed with what was then called familial tremors in the early ’90s. Since his diagnosis, life has grown progressively harder.
“I wake up in the morning and immediately notice it,” Patrick said. “It can get better or worse throughout the day, depending on the day — doing things like drinking coffee, moving my mouse around the computer screen, little things.”
“I see the frustration,” Patrick’s wife, Diane, said. “And he says he doesn’t get mad, but he does. In the beginning, I didn’t recognize it at all. But now, I really try to help. Sometimes it’s just easier if I do things, because he’ll spill it. Just watching him eat and miss his mouth [is so hard]. And we do laugh about it, because that’s how we get through it. But I know how frustrating it is.”
He tried several medications, but they didn’t work. He began scouring for a more permanent answer.
Patrick first discovered HiFU roughly five years ago, as he was researching new treatment options for essential tremor patients. He wanted to have the surgery immediately, but he’d have to travel to receive it. Plus, his insurance wouldn’t cover the procedure at the time. But this past summer, he learned Norton Neuroscience Institute had acquired the technology. He quickly scheduled an appointment with movement disorders neurologist Justin T. Phillips, M.D., at Norton Neuroscience Institute. Then Patrick underwent evaluation and was felt to be a good candidate for the surgery.
Bob noticed his tremors back in the 1970s. Small tremors were made worse by intense exercise. They were frustrating, but they were something he could live with.
In 2012, however, Bob’s life changed dramatically when he was involved in a motorcycle crash. Six months later, the tremors came on with a vengeance. They got progressively worse, affecting every aspect of his life. Roughly three years ago, they became insufferable.
“I don’t go out to eat; I don’t pour milk or coffee; I have to drink from a straw,” Bob said. “It’s unbelievable when you think about it, the things that I’ve stopped doing.”
A recent visit to the gas station showed how tremors can make otherwise routine tasks impossible.
Bob was there to buy some protein bars after a workout. He didn’t have cash at the time, forcing him to pay with his card. Only problem — his tremors prevented him from steadying his hand enough to fit his debit card into the card reader. The line was building up behind him. So was his embarrassment. Eventually, after a few seconds that felt like hours, Bob had to give his card and his PIN to the clerk, who completed the transaction for him. He ran out of the store and immediately changed his PIN.
“It was packed in there,” Bob said. “And there was a big line and they could see it. And it’s just so embarrassing. People are looking and saying, ‘What’s wrong with this guy?’ And I saw a lady and this guy just looking at me. I wanted to say something, because it’s irritating. But this is why I carry cash. That way, I can just pay in cash and if there’s change to give me back I just tell them to keep it for the next person. I don’t even keep track of my change. You have no idea how many times I just want to run out of stores and back to my car and not go in.”
Bob knew he needed help.
He visited with Jason L. Crowell, M.D., also a movement disorders neurologist at Norton Neuroscience Institute. Dr. Crowell explained HiFU and advised him on next steps. After a few evaluations, Bob was felt to be a good candidate for the procedure, to be performed by Abigail J. Rao, M.D., stereotactic and functional neurosurgeon with Norton Neuroscience Institute.
“I was nervous, but I was more excited than nervous to have it done,” Bob said. “When Norton Neuroscience Institute called me and told me they scheduled me to see Dr. Rao, I was shocked.
“I told her, ‘You’re going to be able to get me before Christmas?’ She said, ‘I believe I can do that.’”
HiFU treatment, also known as high-frequency focused ultrasound or MRI-guided focused ultrasound, is an incisionless brain surgery, in which more than 1,000 ultrasound waves are focused down to the millimeter, creating heat that forms a small lesion, or ablation, in the tremor-causing area of the brain.
The roughly two-hour procedure is performed while patients are lying in an MRI machine. Brief, frequent scans monitor the location, size and temperature of the lesion as it’s created. Patients are awake and alert, allowing the surgeon to test the tremor and neurologic function in real time.
After the procedure, most patients experience dramatic and immediate relief of hand tremor and do not require a hospital stay. That said, the procedure only treats one side of the brain at a time, meaning some patients may wish to have a 2nd surgery at least nine months later to treat the other side.
“This treatment’s exciting to participate in as a physician, because we see these immediate effects and we can interact with the patient,” Dr. Rao said. “I mean, that’s not why we do it, but instant results are part of what makes it satisfying. With a lot of our surgeries, we’re very happy with great outcomes, but we don’t always see them right then and there. So that’s part of what makes it really special.”
The HiFU procedure was approved by the Food and Drug Administration in 2016 after years of clinical trials to determine its safety and efficacy.
Norton Neuroscience Institute Cressman Parkinson’s & Movement Disorders Center is the only site in Kentucky to offer HiFU for essential tremor and tremor-dominant Parkinson’s disease. Norton Neuroscience Institute is also one of the first health care systems in the country to use an upgraded version of HiFU called Exablate Prime. This upgraded technology allows for a faster procedure and improves the patient’s comfort on treatment day. The technology was purchased with $2.8 million in funding through the Norton Healthcare Foundation.
“We have several patients who’ve reached out to us to learn more and are still considering their options,” Dr. Rao said. “And I think it’s only going to continue to expand. Another thing that will expand is its indications, meaning what we might be able to treat with this technology in the future. It’s really amazing to see. I mean, this is not the only or the first neurosurgical treatment that has immediate effects, but getting testable results that don’t involve any implantation into the brain, or even incision, is very exciting.”
The surgery was successful for both Patrick and Bob.
Within two hours after surgery, each stood up from the MRI scanner and walked out. As friends and family looked on in tears of joy, and as the clinical team removed the patients’ helmets, the two men looked down at their hands.
For the first time in years, they didn’t shake.
Both Patrick and Bob performed simple post-procedure tests — drawing spirals, signing their names, even drinking water from a bottle. No shakes. No spills. The improvement was dramatic. The two men stayed for roughly an hour to be monitored for any side effects.
When they were cleared to go, the two men walked out of the hospital visibly changed, ready to do the little things again — go out to dinner, pour a cup of coffee, put their debit card in a card reader.
For the first time in decades, Patrick and Bob finally felt steady.
“I just want everybody to look at it,” Bob said. “I just want everybody to see it. I mean, it was crazy. It was just … it’s unbelievable. I still can’t wrap my mind around it. I am 100% happy. Emotional, of course. It’s crazy.”
“It feels amazing,” Patrick said. “It feels like it’s normal, the way I should be. [I’m] just looking forward to people not being able to see me shaking and thinking, ‘Wow, is this person really nervous?’ So that’s the biggest thing — being still in just about everything I do.”
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