“After a year, I was about 99 percent better. I’m so thankful for the treatment.”
How a young patient benefited from a cutting-edge, non-invasive treatment for tremors.
For five years, Kimberly Giacomini, who has multiple sclerosis, suffered from a debilitating complication — tremors on the left side of her body that were so severe she had trouble walking and couldn’t tie her shoes or hold a drink in her left hand. Today, she’s no longer shaking thanks to a noninvasive procedure that’s being studied at Monmouth Medical Center (MMC).
The treatment, called gamma knife radiosurgery, involves delivering a high dose of targeted radiation to the brain. It creates a small lesion in the part of the brain that’s thought to be overactive in tremors. “Although 'knife’ is in the name, there’s no cutting with gamma knife,” says Ty Olson, MD, Medical Co-Director of the Gamma Knife Center at MMC. “The patient’s life is permanently improved with a single outpatient procedure.” Kimberly had the procedure in December 2015, and her tremors started to subside within a few months.
In one of the follow-up tests to gauge whether the procedure had worked, Kimberly had to pick up a glass of water and pour it into another glass, which she was happy to discover she could do.
“If I’d tried that prior to the treatment, the water would have been all over the floor,” says Kimberly, 38, who lives in Dunellen with her husband. “After a year, I was about 99 percent better. I’m so thankful for the treatment.”
Encouraging results
Kimberly initially tried medication to treat her tremors. (Drugs called beta blockers and anti-seizure medications are typically prescribed.) When her symptoms didn’t improve, she discovered she was eligible to participate in a clinical trial led by Sang Sim, MD, Medical Co-Director of the Gamma Knife Center at MMC. So far, more than 20 patients with various types of tremors that didn’t respond to medication have been treated with gamma knife radiosurgery at MMC. (See “Candidates for Gamma Knife Radiosurgery.”)
At the American Society for Radiation Oncology annual meeting in September 2019, Dr. Sim reported encouraging findings on 18 patients treated since 2013.
“Approximately 90 percent of our patients experienced a significant improvement in symptoms,” he says. “We looked at four different aspects of tremor, including postural, drawing, handwriting and functioning categories, and we saw improvements in all of them.” While most patients experienced life-changing reductions in their tremors six to 12 weeks after treatment, the average amount of time it took to improve was approximately six months.
While a handful of other gamma knife centers across the country have studied the treatment for tremor disorders, Dr. Sim says his group is one of the first to conduct a prospective clinical trial, in which patients are studied over the long term. “We want to further report patient outcomes so that we can establish gamma knife as more of a standard treatment,” he says.
Currently, the standard treatment for many patients with tremors who are not helped by medication is a surgical procedure known as deep brain stimulation (DBS), in which an electrode is placed in the brain. A battery-operated device that generates a pulse is connected to the electrode via a wire implanted under the skin in the upper chest, similar to a pacemaker. Many patients don’t want such an invasive procedure, says Dr. Sim. In addition, some patients may not be candidates for DBS because they are elderly or take medications such as blood thinners.
A better quality of life
Dr. Sim says gamma knife treatment results are comparable to those of DBS. If additional research supports the gamma knife approach, more tremor patients may benefit. “The advantage of this procedure is that it’s a one-shot dose,” says Dr. Sim. The treatment typically takes a few hours, and patients go home the same day.
Tremors typically don’t start improving until a few months or longer after the treatment, but this doesn’t surprise Dr. Sim. “Radiation has a bit of a delayed effect,” he says. “It takes time to create the lesion that disrupts what we believe is a neural pathway that’s contributing to these tremors.” The results, which appear to be permanent, are worth the wait. “It’s rewarding to help patients like Kimberly regain their ability to do things most of us take for granted, like holding a drink,” he says. “Kimberly’s young, and she should be able to do these things. When we saw that improvement in her, it brought tears to our eyes.”
Candidates for gamma knife radiosurgery
Tremors are involuntary muscle contractions that cause uncontrollable shaking, or trembling, in one or more areas of the body. They usually affect the hands and arms but also may occur in the legs, torso, head and vocal cords. Patients who suffer from the following types of tremors experienced improvement in the Monmouth Medical Center study of gamma knife radiosurgery:
- Essential tremor, the most common type, can affect various parts of the body, but it affects the hands most often. It causes trembling while a person is performing a task, such as eating or writing.
- Tremors related to Parkinson’s disease, a nervous system disorder
- Tremors related to multiple sclerosis
- Tremors with no definitive diagnosis
To learn more about this treatment option for tremors, call the Gamma Knife Center at (732) 923-6562.