- [Announcer] Your Fantastic Mind, brought to you in part by Dennis Lockhart, in memory of Mary Rose Taylor, and by.

(bright music) (bright music continues) - Welcome to Your Fantastic Mind.

I'm Jaye Watson.

It's not often we get to use the words game changer, but that is what we're going to show you today.

The interesting part of what we're going to show you is that it's something that's been around for a long time, but is being used in a novel way.

This innovative FDA-approved treatment is called high intensity focused ultrasound, and you're familiar with part of it, because it relies on MRI and ultrasound technology.

The result is the ability to treat essential tremor without brain surgery, without sedation, without making an incision at all.

Duward McDonald is the first person to ever have this done at Emory and allowed us to document his experience.

(bright music) - [Mac] And I like mowing.

(motor rumbles) I like it out there, sweating.

- [Jaye] Duward McDonald, Mac to his friends, has never shied away from hard work.

- [Mac] I mowed this whole yard several times with a push mower.

- [Jaye] At 75 years old, he is not slowing down, but he has run up against a foe.

- [Mac] I said I've had it ever since I can remember.

- [Jaye] One within him, one that is making the small things impossible.

- The worst part is writing.

- [Jaye] Indeed, when Mac tries to write, this is what happens.

(Duward sighs) When you were doing that, you have no control over that hand?

- No, no.

- [Jaye] Yeah.

It's doing its own thing?

- Yeah.

(table rattling) - [Jaye] It is a tremor in Mac's right hand, and it has worsened in the last five years.

Eating is not easy.

- The only issue is when I get it about right here, you know, you see my hand shaking now.

But if I haven't got a spoonful of peas, I'm good.

(laughing) - [Dorothy] We have lima beans, and we have green beans.

No, I did not notice it the first time.

It was not like it is now.

It's fun to have a garden.

- [Jaye] The best part of the last five years?

Mac meeting Dorothy.

- [Dorothy] And these are really small.

- [Jaye] A long-time widower, they're now married.

- He loves blueberries, and he loves a cup of coffee in the morning- - She is the greatest woman I've ever been around, I think she really is, and I'm not saying this for the camera, she's just a wonderful person.

- Oh, I love him.

He's dear.

Yeah, those are fine.

- I think it frustrates her to see me struggling.

And that's not fair to her to have to worry about my problem.

(birds chirping) - [Jaye] Mac was originally misdiagnosed with Parkinson's disease.

- Good day!

I'm Doug.

I'm gonna be your- - Okay.

- [Jaye] But finally got an accurate diagnosis of essential tremor, a condition that impacts over three million people across the country.

- Essential tremor is tremor, and essential means that we don't really know what causes it.

We've been working on this for six years.

- [Jaye] Emory neurosurgeon, Dr. Bob Gross.

- Essential tremor is sort of the sick joke disorder, or disease, if you will, in that we both can be sitting here perfectly fine.

A patient with essential tremor like Mac can sit quietly and people will look at him and say well, you don't have anything that's wrong with you, and it's only when you actually try to do something that it kicks in to then screw everything up.

- If I sit here and hold it for five minutes, it'll get a lot worse.

(soft piano music) - [Jaye] Essential tremor is not dangerous, but it does progress over time, and can really impact quality of life.

- Essential tremor is monosymptomatic.

It only has one symptom, that tremor.

So these patients are in as good health as anybody else.

They just have tremor.

So they're vibrant.

It gets worse when you get older.

Many of them have onset of it when they get older, and so they are doing great, they're retired from their job, they want to go out to eat all the time, or play golf, and they can do everything except all those things we want to do in life to enjoy.

- Unless you've had something like this, you don't know, you have no idea how much of a nuisance this is.

It wants to always take off.

You know?

- [Jaye] It has even change Mac's voice.

You can hear the tremor in it.

- You can overcome it.

You can get stuff done.

But it's still, I mean, it's on my mind, 24/7.

- In Mac's particular case, he has tremor, and that tremor involves a circuit that goes into the thalamus and then into the cortex.

We call that area the ventral intermediate nucleus.

And that's our target.

- [Jaye] Until now, treatment for essential tremor has required invasive brain surgery.

(tools whirring) Something many people living with tremor are hesitant to undergo.

But Mac will be the first person ever at Emory to have his tremor treated with focused ultrasound.

Ultrasound, as most of us know it, is an imaging method that uses sound waves to produce images of structures within your body.

Think of those treasured images of babies in the womb.

This ultrasound is similar, yet very different.

Very powerful.

- Focused ultrasound, like some of the other techniques we've talked about in the past, has been around for a long time, many decades.

What is new is both the understanding of how it works, and how it can be controlled and done safely, as well as technology innovation, that accomplishes both the effectiveness and the safety.

In focused ultrasound treatments, we're trying to create thermal heating at a particular spot, an envelope in the brain.

(machine buzzing) - [Jaye] This innovative FDA-approved treatment uses high intensity focused ultrasound technology guided by magnetic resonance imaging, MRI.

For patients living with essential tremor, or Parkinson's related tremor that doesn't respond to medication.

Focused ultrasound will be used to ablate or destroy the spot in Mac's brain that is causing his tremor.

- And about how tall are you?

- [Jaye] There will be no sedation, no incisions, no pain, and no hospital stay.

But as the first, there's still a lot to do.

- Ready?

- Ta-da!

- I'm gonna taking you down to the motion lab.

- [Jaye] Today, Mac is in the motion analysis lab at Emory Brain Health.

- Essentially, what we're gonna do today is if you look around, there's 14 cameras around here.

They are gonna measure your movements 120 times per second.

Our main focus today is the tremor as well as your walking.

We're gonna put 60 markers on your body.

They're reflective markers that will help the cameras see and measure the movements.

- [Jaye] Mac goes through a series of exercises.

- [Christine] Can you do this for me?

Arms down.

You're gonna do some pointing tasks.

Now I want you to make a circle about the size of a basketball.

I wanna capture as much of the tremor as we can get.

- [Jaye] The 14 cameras capture the movement of his body and his arm and hand.

- Ready?

Go ahead.

- [Jaye] Dorothy watches Mac do this final preparation before the procedure.

Year after year, things have only gotten more difficult.

- [Christine] That's fine.

We're done.

- [Jaye] Next week, this all might hopefully change.

- I'm excited about it.

I'm really looking forward to it.

(birds chirping) - [Jaye] On his west Georgia front porch with the procedure just a few days away, Mac is optimistic, and realistic.

- Dr.

Gross is gonna give it his best shot.

That's it.

That's all I want the guy to do.

What happens happens.

If it turns out great, that's great.

If it doesn't, then you deal with it and move forward.

- [Receptionist] All right, you ready for your big day?

- I'm ready.

I've been ready for four and a half years.

- [Jaye] Mac and Dorothy are at Emory Brain Health before the sun rises.

- Thank you for your patience with us this morning.

- Oh, no.

It's well worth the wait, believe me.

(soft inspiring music) - [Jaye] The MRI lab is filled like never before with neurosurgeons, neurologists, radiologists, physiologists, and the people who work for the company who created this focused ultrasound system, INSIGHTEC.

- Do you have any questions about the procedure?

- Yeah.

Why am I awake?

- We need to be able to follow the tremor, so we need to see the tremor, and see it get better.

(razor buzzing) - [Jaye] And then a mandatory part.

Mac's head is shaved.

- You know you have the expert in this, because I do this all the time.

- [Mac] Get it from both sides.

- The entire head needs to be shaved.

So in order to have good contact of that water membrane with the skin, we can't have hair in the way.

The hair is going to harbor a lot of air, and air is our enemy.

- Whose head shines the most?

- Here he is.

I thought you'd want to see the haircut.

- [Dorothy] Oh, hey honey!

Oh!

I like it!

(nurse laughs) That looks good!

- You like it?

(Dorothy laughing) Here.

- Okay.

Give me, let me give you a kiss.

- [Jaye] A quick kiss, and Mac is gone.

- Thank you.

- Look at my finger.

- [Jaye] Mac is run through a neurological exam that will be used as a baseline, including asking him to trace a spiral.

- [Nurse 1] Okay, try the little one- - [Jaye] And to draw straight lines without his hand touching the paper.

- [Nurse 1] And one more.

- [Robert] But you'll feel a lot of pressure.

We'll apply this stereotactic frame, so it gets screwed in in four places, which, of course, is painful, with these four pins.

We'll inject those sites with lidocaine, to numb them up.

- [Jaye] After they put the frame on Mac's head, he is led to the MRI.

- This way.

To the right.

- [Mac] Ah!

- [Robert] All right, this is your home for the next couple hours, okay?

- [Mac] All right!

- [Robert] We'll situate him into the helmet.

The helmet is attached to the table.

- [Tech 1] Gonna be pretty tight.

- [Robert] And plugged into the MRI scanner.

- [Tech 1] You feel ridiculous yet?

- [Mac] Yeah.

(all chuckling) - [Robert] Good Halloween costume.

- [Tech 1] You're ready for Halloween.

- [Robert] We'll situate him in there, and then we will fill the helmet full of water, make sure that we have a good seal.

All right, and you can fill up a little bit more.

And then we start right away with some imaging.

(machine buzzing) - [Jaye] On the table, Mac's head is inside a helmet filled with 1024 transducers.

Each one sends out a beam of sound waves into his body.

In this case, the transducers will all be trained on a precise spot in Mac's brain.

The procedure will be performed inside the scanner, allowing Dr.

Gross and the team to see what is happening inside Mac's brain.

(soft music) - The program itself decides which transducers to put on of the 1024, to be able to get our target focused, and then we do a test pulse, where we heat up the tissue a little bit.

We have to see where we're heating.

So we avail ourselves of this property of an MRI scanner, where it can tell the temperature of the brain.

When the heating happens, the phase, if you will, of the water molecules that are in that region that gets heated get shifted, and the MRI picks up this phase shift.

So it'll give us a thermal map, that will be depicted in colors from blue to red, red being the warmer colors, being the hotter areas.

So we can see the area that's being heated, and we can measure that temperature change precisely.

- [Jaye] Instead of being in an operating room with a scalpel, Dr.

Gross is in the control room with a computer mouse, using it to control the advanced software that will deliver those 1000 plus ultrasound beams into Mac's brain.

Guided by the MRI, they begin to precisely ablate or destroy the target deep within Mac's brain, in his thalamus, the part of his brain relaying the motor signals that caused his tremor.

- So when we see that the temperature change is overlapping the area that we've chosen to make the ablation, then we know we're good to go.

If it's not, we make some adjustments, and get it aligned just perfectly.

- [Nurse 2] All right, so we're gonna start that first treatment now, okay?

- At that point, we're ready to give a test dose that is enough so that it'll create a benefit.

This is the preop?

- That is the preop that we want cross there.

It's about 1.5 millimeters a medial to your target.

See, this is 16.5 from midline, or 6.8 from PC, and we're on ACPC point, so we're at zero.

- [Robert] And we wanna go up there?

- I think you guys probably end up in the same spot.

- [Robert] Right.

- The way he measured, for him, 10.5 to 0.5, or something.

- Can we go and check on him?

Let's check on him.

- [Svjetlana] And push down?

Okay.

And you feel this okay?

- [Mac] Yup.

- [Svjetlana] Okay, all right.

And give me a big smile.

- [Jaye] After the first ablation, Dr.

Gross, along with neurologist Dr. Svjetlana Miocinovic, and team members enter the MRI, and do the same neurological exam and drawing test they did with Mac before.

- Here's your pen.

Okay, so don't brace your hand.

Only pen touching the paper.

(pen scribbling) - No pain?

- Nope.

- [Nurse 3] All right, how's your back?

- [Robert] How's it looking?

- [Svjetlana] Well, it's not any different, so this was just the first treatment.

So we'll keep going.

- Cool.

We did a small test lesion, which is not a permanent lesion, just to see if he felt anything.

- [Jaye] They discuss the approach for the next treatment.

- I think we gotta get up past 55, so I mean, he's not having any pain, so we can keep ablating.

And that's 63, anywhere within this.

It's not just at the- - Correct.

- Target.

- If it picks up 63- - Yeah.

- That's correct.

- Well, it will be hottest at the target, so.

All right.

Ready?

- We are ready.

- Lot of room on the lateral side here, so, and we haven't seen any parasthesias, so I'm comfortable going up a little higher.

- [John] Here comes that next treatment, Mr. McDonald.

You're doing great.

- [Jaye] The team enters the MRI.

- All right, so just gently squeeze my hands.

- [Jaye] Mac is run through the neurological exam first.

It's an immediate change.

- Arm up in front of you, fingers slightly spread, hold it.

Okay, bend your elbow and hold it in front of your face.

- [Mac] Ooh, that's a lot better, isn't it?

- Mm-hmm.

- Mm.

- Better, okay.

- [Jaye] Then the pen and paper test.

- All right, here's the pen.

All right, so only pen.

- I can't, because it's, there we go.

- Okay, okay.

Only pen touching the paper.

Don't brace your hand.

(pen scribbling) Excellent.

Okay, smaller one.

- Wow.

- (laughing) Making progress.

- All right, straight line.

- Yeah.

- Right.

- I can't see.

- You need it, I'll bring it up.

- [Mac] There we go.

There.

- Okay, another one.

One more.

Beautiful.

All right.

- [Robert] All right, we're getting there.

- [Mac] Yup.

- [Nurse 4] Can I have you for two minutes?

- [Robert] Huh?

- [Nurse 4] Can I have you for two minutes - [Svjetlana] All right, so we are making progress.

- It's right here.

- Much better.

- And then that was really the first ablation that we did at full temperature for benefit, and you clearly see that he's had a good benefit from that.

He's had a little bit of tingling going down his arm, which is okay.

We're probably gonna move the next lesion a little bit away from that spot that gives that sensory part.

The sensory nucleus of the thalamus is right behind the motor nucleus.

So if you get any spreading of the heating into the sensory nucleus, he will experience it as a tingling in his arm.

(bright music) - [Jaye] The spot being ablated or destroyed is just five to eight millimeters in size.

- [Robert] I'd probably just to maybe 50 more watts.

- [Jaye] It is also in a crowded area.

A millimeter or two in either direction, and you're in the wrong spot.

But when it's in the exact right spot, the spot that has made so many things so difficult for Mac for so many years, this is the instantaneous difference.

They show Dorothy the papers.

- This is the last one I showed you.

- Yes.

- [Nurse 3] And this is the one we just did.

- Oh my god.

It's amazing.

I mean, it's absolutely, it makes me tear up, because he struggled for so very long, that it, to be able to be, make a straight line, or even get close to being in a circle, it's just absolutely amazing.

(bright uplifting music) - [Jaye] The team huddles to discuss.

- [Robert] You know, he's definitely got a lot of benefit.

I mean, he could have more benefit.

- [Svjetlana] Yeah, yeah.

- So the question is, make a bigger lesion at this spot?

I'd probably do that, rather than move any lower, but the other possibility is move it more dorsal.

- Might wanna do that from the initial spot?

- From the bottom, yeah.

- [Jaye] Harvard neurosurgeon Dr. John Rolston is part of the group.

He trained under Dr.

Gross as a med student, and now a neurosurgeon himself, has been performing focused ultrasound for a number of years.

- And so that experience of doing these cases before was good, so we can have a second pair of eyes for Bob on his first case today.

- [Robert] If you want, you can even go on this image and watch it go viral.

- [Jaye] Dr.

Gross and the team do another ablation with focused ultrasound.

- [Robert] Let's go check him out and see, see how we did.

- [Jaye] And then they enter the room.

- How did this one go?

Did you feel anything?

- [Mac] A warmth was, it was hotter, it seemed like it lasted a little bit longer.

- [Robert] On your head?

- [Mac] Yeah.

- [Robert] Okay.

- [Svjetlana] All right, give me a big smile.

Stick your tongue out.

Okay, good.

- [Nurse 2] All right, spread your fingers.

Hold them spread.

Hold them spread.

Okay, all right.

So now arm up.

Let's see the tremor.

Okay, in front of your face, bend your elbow in front of your face.

Hold it there.

- Ooh.

- Ooh.

- It's even better.

(Mac laughs) - That's so good!

- All right.

Let's do another spiral.

Here's a pen.

- Oh.

- [Tech 1] Was there a 57 in the last one?

- [Robert] Dr. Rolston saw a 57 in there.

- Yeah.

- But even if it was 56, it was 56 for- - Good.

- [John] Well, even better.

Look at that.

- [Robert] It looks a lot smoother.

- Beautiful.

One more.

- [Robert] Oh man, your handwriting's gonna be better than mine now.

(all laughing) - [Svjetlana] All right, good job.

All right.

- [Robert] All right, we're done.

You're all done.

- All right.

Thank you, thank you, thank you.

- You're welcome.

We did another lesion.

I think you filmed the circles, and a straight line, so 90% better than when he started.

He's ecstatic.

He can feel it, as soon as he put his hands up, he said okay, that's really great.

- I'm feeling great.

- [Nurse 3] How's your tremor?

- [Robert] Says it all, doesn't it?

- [Mac] What tremor?

- So went all according to plan, I mean, having him walk out here, gonna go home today.

- Wave to your wife.

- Hi, honey!

- [Dorothy] Hi, honey!

(all chuckle) - [Robert] Not stay overnight, no pain.

- Be able to write again.

- Be able to write again.

- Be able to sign his name.

- Yeah.

It's transformational.

- [Svjetlana] Straight line.

Let's see those straight lines.

- [Mac] I think drawing a straight line is what really made me feel good.

I haven't been able to do that for years.

(soft uplifting music) - [Jaye] There is the high tech focused ultrasound system, there is the collective knowledge and expertise in a single room.

At the end of the day, it's the hand of one man on paper that says everything that needs to be said.

- Quite a difference.

- Quite a difference.

I'm gonna go show your wife.

Well, this is what we did today.

- It is absolutely amazing.

Thank you.

- [Robert] That's before, and that's after.

- Oh my god, I can read his name.

That's the first time in three years that I can read his name.

And this is amazing.

- [Robert] Yeah?

- I can't believe the straight lines.

I've never seen him be able to draw a straight line, and being to stay in the circles, it just, it's absolutely amazing.

Thank you so much, Dr.

Gross.

- [Robert] You're welcome.

- We can't thank you enough.

- My pleasure, oh.

This is thanks enough.

(soft uplifting music) - [Jaye] Words on paper are powerful.

So is this.

(all applauding) - That's awesome!

Yay!

(all cheer) - Well, we're proud of you for taking a chance on us on our first day.

- No brainer.

- And, a little bit less brainer.

(all laughing) This was a long journey for us, and a lot of people worked really hard to get this through.

And so we're gonna give you the opportunity to handle a knife probably for the first time in a long time.

I'm gonna stand back.

(all laughing) - [Jaye] With a hand almost as steady as his surgeons'- (cork pops) (all clap and cheer) A toast to advances in science and technology that improve lives.

- Cheers.

- I appreciate your work.

- My pleasure.

- And changes them in a single morning.

(soft music) As you just saw, focused ultrasound is immediately life-changing.

We watched Mac go from not being able to control a pen to drawing straight lines and writing entire sentences.

This procedure can change the lives of millions of Americans living with essential tremor, or tremor from Parkinson's disease, but the future of focused ultrasound is even bigger, and could have profound impacts for countless others.

Research and clinical trials are exploring its use in treating brain tumors, areas of Alzheimer's disease, different movement disorders, even epilepsy, and psychiatric disorders.

Focused ultrasound effects lasting change deep within the brain, and you're heading home by lunch.

That makes it a game changer.

That's gonna do it for us this week.

See you next time on Your Fantastic Mind.

(bright exciting music) (bright music continues) - [Announcer] Your Fantastic Mind, brought to you in part by Dennis Lockhart in memory of Mary Rose Taylor.

And by.