HIFU (High-Intensity Focused Ultrasound) Surgery

[daedalus]

It will be available at the latest next year. For a price since, as far as I know, only one clinic is experimenting with this surgery. I guess they will be clogged with demand. They also treat neuropathic pain like phantom limb pain. The machine used, the ExAblate 4000, exists in only two clinics.

 

[Markku]

It will be available at the latest next year. For a price since, as far as I know, only one clinic is experimenting with this surgery. I guess they will be clogged with demand. They also treat neuropathic pain like phantom limb pain. The machine used, the ExAblate 4000, exists in only two clinics.

Only consultation over 3000€, the treatment another 25 000 - 34 000€?

Seems interesting nonetheless, I hadn't heard of this at all before.

magnetic resonance guided high-intensity focused ultrasound (MRgHIFU). It consists in very localised (3-4 mm) ablations of cerebral tissue in the thalamus. My crude understanding of the thing is that by destroying the right part of the thalamus they disrupt the thalamocortical loop responsible of thalamocortical disrythmia (TCD). It is interesting to notice they include tinnitus in a broader theory of TCDs.

 

[mock turtle]

I'd give up a lot to have it work.

I'd be devastated to give up a lot and have it not work.

I need more data.

 

[jamie5136]

I would sell an organ to get this surgery. Been trying to contact them, but they don't chat back.... for 40k, I would think they would want to help. I read though that it might help fify percent of a person's tinnitus and it is still experimental, but sounds logical. Anybody have any news?

 

[daedalus]

From a French forum. They are still doing clinical trials and will begin to accept patients in 2013. The engineer contacted by phone said the price would be around 25 000 €.

 

[Meecat]

How do they know what part of the thalamus to ablate? TCD theory by llinas and their research group is a proposed theory, it helps explain percept but not fully. I forgot the reason why. Still, sounds expensive but if it turns out to work I wouldn't mind having my thalamus ablated, if you know what I mean

 

[daedalus]

I have recieved indirect news from the clinic in Switzerland. They have said they have cured hyperacusic patients. Also, apparenty, tinnitus patients have had an amelioration in two phases: a "quick" noticeable relief shortly after the surgery then a furter diminishing along the months. I may contact Pr Jeanmonod if someone is interested by more precise details. It would take some time.

I don't know what kind of tinnitus they treated. I know some are more neurologically complex than others.

Also, i have heard a clinic in France is going to experiment with the same procedures. If it succeeds, it could be covered by the French social security but for French citizens of course. So, it seems it is spreading.

Meecat: If i recall well, they stimulated cortical areas one by one and observed the matching thalamic zones.

 

[Louise]

This sounds like the nearest to a 'cure' get. Bound to be side effects of losing some of the Thalamus. Better than having T though I would think.

I may have to get French citizenship if this ends up on their Social Security.

 

[click]

I used to own a house in Normandy - perhaps now's the time to get another one. They're pretty cheap too!

 

[Louise]

Can I stay, long-term?

 

[click]

It's an idea eh? How about an open house for T sufferers...

 

[Louise]

Yep. We would have to work there as well though to get citizenship. I wonder if Pr Jeanmonod would give a discount on the op for a group booking?

 

[dan]

I live in Canada, I think our public health insurance covers out of country surgery if its not available here - but I will have to ask my doctor about it to be sure.
What about in the UK ?

 

[Louise]

Well, we have the NHS where treatment is free (because we pay a portion of our salaries into it) but I think its only free within the NHS so no out of country stuff.

 

[mock turtle]

yikes imagine paying 34 000€ and for the procedure not to be a success...that would really hurt

anyway, probably take a long time for the FDA here in the usa to approve it,

i have distant relatives in france...third cousins but its unlikely they would adopt me

and the private insurance companies here...well gee whiz... never in my lifetime will those stingy bums ever approve the procedure for older people like me

my best chance is that aliens in a UFO will land , take pity, and fix my broken ears...and we all know that aint gonna happen...ha....ha...ha...ha...ha

hmmmm or maybe i can get ahold of a flask of the harvard stuff LY41175 that restored the hearing in those mice

 

[Louise]

Yeah, how come mice and rats are getting their tinnitus cured left, right and centre in all these trials and we cant?!

It might be time to start rekindling your relationship with those distant cousins....

 

[Lesky]

This could be it - hope to hear more soon from this project!

 

[Lesky]

This seems like a revolution for so many disorders, why is it not pursued in the USA?

Also, any idea how long surgery takes?

I see its only possible to wear ear plugs, because the head is in that "thing". No room for head phones.

For me personally, I would worry if the sound level of the MRI (120-140 dB) might do more damage to my auditory system than the treatment would cure!

With 33 dB ear plugs still would be aprox 90 dB which could cause hearing loss in normal persons hearing if the surgery goes on for hours.

 

[joejunior]

dont know much about this but here are a few links, it appears that it might take a few hours, dont know how effective it is, can be highly focussed to a few mm, , I have only heard some anecdotal evidence which you cant go on, even the peer reviewed success rates can be wrong.

http://www.european-hospital.com/en..._in_MR-guided,_non-invasive_neurosurgery.html

http://www.fondation-fondamental.org/upload/pdf/strasbourg_2011_for_fondamental_2.pdf

 

[joejunior]

Would like to know separately for tinnitus / hyperacusis, sample size.

1. definition of success
2. chance of success
3. side effects. short term at least

preferably from a statisically valid double blinded randomized trial etc with

and verification of above
etc ie not just anecdotal evidence, though its thats all thats availble i am all ears, so links would be good

i dont see the hardware being limited to 2 machines at present an issue. it can be easily rolled out in quantity.

sounds promising but hold your horses.

question: why arent ata at least talking about this or helping out?

 

[Louise]

Probably because its French. There's something strange when France is involved (no offence) as I remember looking into the drug Tianeptine (a Glutamate antagonist) which is a French developed drug and finding that its not available in the UK or the US. I read it was some political economic thing.

Anyway, the ATA have just put all their eggs in the Soundcure basket havent they?

 

[joejunior]

i despair - the ata seems to be useless at best.

 

[Lesky]

The producer of the Exablate 4000 is a company from Israel. The current trials are ongoing in switzerland, not france.

 

[joejunior]

Await further news.

This is very promising .

What it wont do is restore auditory function at the coclear level but would interesting what effect if any it has on audiograms.

If the tinnitus and hyperacusis can be ameliorated then if you had hearing damage you would still have to be careful with sounds if your threshold for further damage was low. Thats something I think most people could accept and would be very happy with.

As the root cause of dishythmia is auditory damage, ie hair cells, would be interesting to know if hair cells restoration reverersed the disrhythmia ie Tand H and led to more robust hearing. Hearing restoration is developing by leaps and bounds though we are still not at human trials yet with the exception of the Florida children trials which havent been reported on, at the lab there has been huge progess.

Its great that they are working and and making so much progress on both tracks.

 

[joejunior]

I understand the MRI and the Loreta EEG supposedly allows precise location of the active cells, and the ExAblate 4000 allows precise thermocoagualtion of the located area.

Tinnitus patients show differences from the norm in EEG parameters and this can be seen on spectral density functions - basically frequency plots. ( not to be confused with frequencies as seen on audiograms or tinnitus frequency)

 

[joejunior]

Wikipedia has a good general discussion of HIFU
http://en.wikipedia.org/wiki/High-intensity_focused_ultrasound

 

[dan]

As you all know, I am terribly suffering from my extreme tinnitus and I am willing to undergo any type of surgery to cure or ameliorate my condition. However I do not have 25000 Euros. What I do have is OHIP. Ontario Health Insurance Plan. It is a publicly funded provincial health program.
I live in Ontario, Canada, and this is an excerpt from their official government health site:

OHIP Out of Country Services - Prior Approval
Prior approval from the Ministry of Health and Long-Term Care is required in order for you to receive funding for OHIP insured hospital and medical services out of country (OOC). Written approval MUST be received from the ministry before OOC health services are received.http://www.health.gov.on.ca/en/public/programs/ohip/outofcountry/prior_approval.aspx#2

However, it also says:
"Treatment that is generally accepted in Ontario as experimental, for research or a survey, including clinical and drug trials are also not covered by OHIP."
So my question to anybody who might give an educated opinion, is what status does this procedure have today and if its still considered an experimental procedure, if so, when will it become an official medical procedure, or whatever you call it when its not experimental or a trial procedure.

THANK YOU.

 

[Lesky]

Do you think it would be possible to treat hyperacusis and tinnitus during the same surgery?​

 

[Lesky]

The MRI used by the clinic in switzeraland is a standard GE Discovery MR750 3.0 Tesla. With sound level of at least 110 dB according the GE.

With a LDL of 40 dB myself, putting myself in for at least 80 dB for several hours is impossible. It would kill me.

I had a bad experience in 2004 with 1.5 Tesla of aprox 95-100 dB. And the 3.0 Tesla is much louder as its faster and has better picture quality. And in 2004 I was in much better shape!

But for all of you with only tinnitus, I guess you should be OK, but if you go to hyperacusis message boards there many who got hyperacusis due to MRI even though wearing hearing protection.

If the MRI were silent I would be ALL OVER the clinic in switzerland to treat me! I am crushed by the fact that I could maybe actually be helped if not for the noisy MRI.

I will have to hope for more silent MRI in the future, but silence is not a priority for MRI companys as we now so I might never be able to be helped, its devastating.

 

[joejunior]

Part of reply from neuroscientist involved in tinnitus research, I summarised the bits I understood in a post above.
Its a independent 2nd opinion, from someone not involved in HIFU directly, but its positive about using HIFU so look forward to trial results, and wonder why this subject isnt being picked up more widely. HIFU for neuroscience is a new field, but HIFU has FDA approval and looks promising. Any questions about this I will try to answer

REPLY :
> I have no personal involvement in the field of therapeutic brain
> stimulation or lesioning for tinnitus relief, so I can only respond
> based on my slightly outsider knowledge (coming from a neighbouring
> but different part of tinnitus research).


> I personally like the idea of both brain stimulation and targeted
> lesioning for relief of neurological conditions, including tinnitus,
> in principle. I also consider it a major benefit if the intervention
> does not require a craniotomy, as this is likely to make it much more
> widely deliverable as a treatment. Of course we will need to see how
> the large-scale long-term studies pan out to decide whether each given
> intervention is worth making into a part of the routine care
> structure.
>
> The issue of heterogeneity certainly seems to exist for cortical
> correlates of tinnitus (at least cortical areas besides the auditory
> cortex itself, and possible within auditory cortex also), though I do
> not have a clear sense of how much heterogeneity there is in
> subcortical tinnitus correlates. From first principles, one might
> argue that because tinnitus has a peripheral origin, that the auditory
> periphery would show the most consistent abnormalities, which might
> become more heterogeneous in higher auditory or non-auditory centres.
> From my own results, and literature of which I am aware, there is
> nothing to suggest major heterogeneity of thalamic involvement in
> tinnitus.
>
> In terms of what the relevant functional correlate of tinnitus is,
> this becomes more than just academic if that correlate is going to be
> used to target treatment. Oscillatory correlates, such as those I work
> with, cannot be used to image the thalamus (it does not project out to
> the surface), so are probably not applicable to HIFU (in theory fMRI
> could be used to identify tinnitus correlates in the auditory
> thalamus). Oscillations could be used, in theory, to target cortical
> interventions (both invasive and non-invasive). As a general rule, the
> higher the frequency of an oscillation the harder it is to detect, and
> the less accurate and precise the localisation of its origin is.
> Auditory gamma oscillations are extremely difficult to detect, and
> tend to localise poorly, especially at an individual subject/patient
> level. Delta/theta oscillations are much stronger and localise better
> and more easily.
>
> An additional advantage to using delta/theta oscillations to target
> intervention is that they seem to represent a more low-level and
> fundamental part of the tinnitus generation pathway (the
> thalamocortical input), and are thus a more concrete measure. In my
> data there is nothing to suggest heterogeneity of the relationship of
> delta/theta oscillations in auditory cortex with tinnitus. Gamma, on
> the other hand, is probably a downstream response to the incoming
> tinnitus signal, which is more fickle and more influenced by other
> factors including attention.