No scalpel, no drill: Medical procedure to treat uncontrollable hand tremor a 'game changer'

In a room at Sunnybrook Health Sciences Centre in Toronto, Brian Smith gives one last hug tohis wife, Noreen.

"You're doing really well, sweetheart,"he says to her.

Doctors have finished prepping the 76-year-old patient. She's clad in a blue hospitalgown, her head has been shaved and metallic headgear is attached to her skull.

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She's ready to be wheeled into an MRI room, where she'll undergo a procedurethat her doctors believe will revolutionize the way brain diseases are treated.

Before that happens, Noreen leans into her husband for a kiss.

"Best buddy,"she whispers.

Noreen Smith is among the three per centof the Canadian population who suffer from anervous system disorder called essential tremor.It causes uncontrollable shaking,most often in a person's hands.

Smith noticed the first signs when she was 33.

"It started developing in my dominanthand, which is my right hand," she saidthe day before her medical procedure fromher home inBobcaygeon, Ont.

She went to a specialist who delivered the diagnosis:essential tremor.

Smith really, really excited about treatments potential

8 years ago

Duration 0:48

Noreen Smith sees hope for other patients with diseases of the brain

Justas shocking was what he said next, alluding to a high-profile actor who had the condition.

"This particular person wasn't terriblyhelpful because he said:'Do you happen to know Katharine Hepburn?I'm goingto give you some medication, and you can go home and get used to the idea thateventually you're going to end up looking like Katharine Hepburn.'I wasdevastated,"says Smith.

Simple things were tough

Medication helped for the first few years.

But Smith's tremor was still severeand like others who suffer from this disorder, the shaking worsenedwith simplemovementsor everyday tasks like applying makeupor pouring a glass of water.

WhenSmith triedto do that, much of the water spilledinto the kitchen sink. And when sheattemptedto put the glass to her mouth for a sip, it wasvirtually impossible toaccomplish.

For outsiders, it's hard to watch, but her husband cameto her aid and heldthe glassfor her.

Essential tremor won't shorten Smith's life, but it was definitely affecting her quality of life.

"We're invited out to dinner and I won't go because I'm embarrassed dropping food. Even at food courts, sometimes we'd have a cup of coffee and Brian would have tohold the cup and feed me. It's so embarrassing."

All the more reasonthe Smiths were "absolutely elated" when they heard Noreen was consideredasolidcandidate for a medical procedure called "MRI-guided focussed ultrasound"technology, a treatment approved last month by Health Canada.

No scalpel, no drill

"This is a game changer," says Sunnybrook neurosurgeon Dr. Nir Lipsman."It reallychanges the way we think about surgical treatments for tremor. No scalpel needed. Nodrill needed."

Procedure a 'game changer'

8 years ago

Duration 0:45

Dr. Nir Lipsman compares tremor treatments from past with present

Instead, the treatment uses a more non-invasive approach.The technology allowsdoctors to focus ultrasound wavesguided by an MRI through a patient's skull toreach an area located deep in the brain called the thalamus.The soundwaves targetand destroy the cells that cause the tremor.

"What we're effectively doing with this procedure, in a non-invasive way, is killingthose neurons and destroying those neurons with high frequency focussed ultrasound,"says Lipsman.

He is part of an international team that studied 76 patients with essential tremorin a clinicaltrial in 2013.

After three months of treatment, patients who received focussed ultrasound saw their tremors reduced by47 per cent. After one year, itwas a 40 per centreduction in tremors.

That's compared to less than oneper cent improvement in those who received a so-called "sham procedure" or placebo.

Side-effects included gait disturbanceand numbness that decreased over one year.

The results were published today in theNew England Journal of Medicine.

The technology "will open up a new era that will revolutionize the way brain diseaseswill be treated, eventually benefitting millions of patients,"says Dr. KullervoHynynen, director of physical sciences at Sunnybrook Research Institute. He alsohelped develop the technology.

Lying inside the MRI machine last week at Sunnybrook, Smith patiently enduredthe four-hour procedure.

Like all other patients before her and so far there have beenabout 40 at Sunnybrookshe remained awake and was closely monitored by a team ofneurosurgeons and MRI technicians in a nearby room.

When it was over, when she walked out of the MRI room. Doctors removed thecumbersome helmet, she sat downand performed a few tests for Lipsman.

"Are you able to touch your nose with your index finger?"he asked. She did, guiding a steady hand to the tip of her nose.

"Couldn't do that before,"she said.

She washanded a glass of water. She drank it, without a drop falling. She beamedwith satisfaction.

"This is amazing."

Finally, she wasasked to write her name, a task that hasbeen impossible for decades.

Her penmanship wasflawless.

"Just being able to to hold my hand like that it'smiraculous."

For good measure,she rosefrom her wheelchairand performedan Irish jig.

Doctors hope to apply the technology in the treatment of other diseases likeParkinson's and epilepsy.

For Smith, her objectives are less grandiose:a return to her passions ofgardening and art.But most of all, she looks forward to the simplergestures betweena married couple.

"I will be able to sign my husband's card for our 50th wedding anniversary,"she toldreporters, "which iscoming up at the end of the year."

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Watch CBC'sFacebook Live with the team behind the surgery.