OHSU first in nation to use new, incisionless surgery to treat Parkinson’s

Barely an hour after being wheeled into a clinical space at Oregon Health & Science University on Aug. 27, an Arkansas woman emerged with vastly improved symptoms of the Parkinson’s disease that had plagued her for the past seven years.

The procedure involved a type of brain surgery with no incisions at all.

The intervention used high-frequency focused ultrasound, or HIFU, and it marked the first time in the United States that the procedure had been used outside of a clinical trial for the primary treatment of Parkinson’s. In July, the device’s manufacturer announced that the U.S. Food and Drug Administration had approved the procedure for treating patients with advanced Parkinson’s disease.

“This is a huge step forward for the treatment of Parkinson’s disease,” said Daniel Cleary, M.D., assistant professor of neurological surgery in the OHSU School of Medicine.

The first patient says she is grateful to have her life back.

Carolina Palacios de Ramirez, 76, said she remembers emerging from the procedure with the ability to smile again — a simple but profound expression that eluded her with Parkinson’s. She then cried with joy in the company of her family as she described feeling a new lightness and calmness.

With improved movement, her confidence has grown since the procedure.

“I love spending time with my children and grandchildren — they are my greatest joy,” she said. “I enjoy cooking, walking and being outdoors. I thank God every day for another chance to live without tremors and to smile again.”

Cleary performed Ramirez’s procedure and has since treated three other patients with Parkinson’s using the technique. The procedure is so new that it’s not yet covered by most insurance providers. Once the procedure is regularly covered by insurance, he anticipates it will serve a large, unmet need among patients who aren’t candidates for the standard surgical treatment involving the placement of a programmable deep brain stimulator.

“This new development in focused ultrasound technology is the latest in a long history of neurosurgical innovations at OHSU,” said OHSU President Shereef Elnahal, M.D., M.B.A. “It also represents a milestone in minimally invasive surgery to improve the health and well-being of patients here in Oregon — and, indeed, across the country.”

Expansion to Parkinson’s

Previously, focused ultrasound was primarily approved for treatment of essential tremor — a more limited condition that OHSU has been treating with the incisionless procedure since 2022. The program has treated more than 400 patients with essential tremor since it was started by Ahmed Raslan, M.D., chair of neurological surgery in the OHSU School of Medicine.

Adding Parkinson’s expands the pool of patients who may benefit from the treatment.

In addition to involuntary tremor, the symptoms of Parkinson’s can include muscle stiffness, rigidity and slowness in movement. For some patients, advanced forms of Parkinson’s can be much more debilitating than essential tremor.

“The effect on patients is very different in Parkinson’s,” said Delaram Safarpour, M.D., associate professor of neurology in the OHSU School of Medicine.

Focused ultrasound works by directing more than 1,000 sonic beams through the skull to create a small lesion in the focal point of the brain causing the symptoms. It requires no cutting, no anesthesia, and is usually finished within an hour. Guided in real time by magnetic resonance imaging, known as MRI, the neurosurgeon precisely targets a focal point that’s slightly different in Parkinson’s than in essential tremor, zeroing in an area within the pallidothalamic tract of the brain.

“The neural circuits that control essential tremor are different than that of Parkinson’s, and we now have the ability to target both,” Cleary said.

Comprehensive treatment options

Ramirez was diagnosed with Parkinson’s seven years ago, and subsequently was treated with medication and physical therapy. Nothing seemed to help.

She was reluctant to undergo deep brain stimulation, or DBS, the surgical technique that was pioneered in the U.S. more than three decades ago by Kim Burchiel, M.D., professor and former chair of neurological surgery in the OHSU School of Medicine. DBS is ideal for many patients because once it’s implanted, the neuromodulator can be turned on and off and adjusted over time.

“HIFU is not a replacement for DBS by any means,” Cleary said. “But it’s another option for people, especially for those who would benefit from DBS but aren’t candidates for the surgery.”

Safarpour noted that by offering both procedures for Parkinson’s, OHSU patients benefit from a comprehensive approach to treatment.

“We’re at the forefront of bringing the most advanced technologies to the benefit of our patients,” she said.

That’s the reason Ramirez sought out OHSU all the way from Arkansas in the first place.

Her daughter, Carolina Sandoval, found a video online about the incisionless form of treatment offered at OHSU. She connected with the program’s coordinator, Christine Larsen, RN, who helped to organize necessary appointments and other matters as she prepared to fly to Portland from her home in Springdale, Arkansas.

She has advice for others in her position: “Don’t lose hope,” she said. “If you’re scared, like I was, trust the doctors at OHSU. This treatment gave me my smile back and changed my life.”