Nuova frontiera all'Istituto Neurologico Besta di Milano, dove è presente una delle più avanzate apparecchiature per il trattamento con ultrasuoni focalizzati guidati da Risonanza Magnetica
A groundbreaking new treatment option is now available for patients with neurological disorders at the Besta Neurological Institute in Milan, Italy. The institute utilizes highly advanced equipment for focused ultrasound therapy guided by Magnetic Resonance Imaging (MRI), offering a non-invasive alternative to traditional surgical procedures. This technology allows for precise targeting of brain areas, potentially improving outcomes and reducing recovery times for patients.
Two Distinct Applications
Focused ultrasound in neurology serves two primary purposes: to destroy targeted areas of the brain causing dysfunction, or to temporarily increase the permeability of local blood vessels, allowing medication to reach diseased tissue – such as in the case of tumors – that would otherwise be inaccessible. High-frequency ultrasound is used for targeted destruction, while lower frequencies are employed to enhance drug delivery.
High-Frequency Precision
As an example, essential tremor – a neurological condition causing involuntary shaking – can now be managed with this focused ultrasound technique, avoiding the need for deep brain stimulation (DBS). DBS requires opening the skull to implant an electrode connected to an external battery. With this new approach, patients enter an MRI machine, which directs the ultrasound waves with extreme precision to the targeted nerve cells. The MRI also monitors the temperature of the cells as they are affected by the ultrasound.
Reversible Effects and Ablation
During the procedure, the patient remains awake. Once the temperature reaches 45 degrees Celsius, the patient is removed from the MRI to assess if the tremor has subsided. At this point, the effect is still reversible. If successful, the patient is returned to the MRI for completion of the procedure, raising the temperature to 55 degrees Celsius, resulting in permanent destruction (ablation) of the targeted tissue.
Low-Frequency Drug Delivery
“High-frequency ultrasound is best suited for treating small areas,” explains Francesco DiMeco, Director of the Department of Neurosurgery at the Besta Institute and Professor of Neurosurgery at the University of Milan. “However, this is not typically feasible for tumors, as the area requiring treatment is usually larger and such an aggressive approach could cause bleeding or other complications. In these cases, the lower-frequency option is used. This temporarily widens the junctions between cells in the brain’s blood vessel walls, allowing medications that normally wouldn’t be able to pass through to reach the tumor.” The Besta Institute has already treated 24 glioblastomas using this experimental technique.
Future Potential
Beyond essential tremor, the technology holds promise for treating other conditions. “We can currently intervene in several cases of tremor caused by Parkinson’s disease, or in neuropathic pain,” notes DiMeco. “But it could also be used for other neurological conditions, such as Huntington’s disease, or even Alzheimer’s disease to facilitate the passage of antibodies directed against amyloid plaque. We believe it may also be useful for conditions like obsessive-compulsive disorder and treatment-resistant depression.”
The treatment is now covered by the Italian National Health Service. “Yes, the Lombardy Region has approved reimbursement,” confirms Professor DiMeco. “With the new Prime technology, we expect to treat at least 130-150 patients per year, thanks to the shorter procedure duration. To address the waiting list and growing demand, we are exploring innovative management projects, such as public-private partnerships, to achieve the goal of obtaining a second device.” He emphasizes that treatment should be reserved for those with a genuine indication and greatest need, and that both the selection process and the procedure itself are carried out by a multidisciplinary team, including a neurologist, neurosurgeon, neuroradiologist, and medical physicist.
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