Pioneering treatment for essential tremor at Trust receives boost from NICE recommendation and new funding appeal

A new treatment for essential tremor being pioneered in the UK by clinicians at Imperial College Healthcare NHS Trust has been recommended by the National Institute for Health and Care Excellence (NICE). NHS England will now need to consider whether to fund the new procedure for suitable NHS patients in England. Essential tremor is a brain disorder characterised by uncontrollable shaking that affects over one million people, with around 250,000 severely disabled by the condition.

Current treatments - including drug therapies, surgery and deep brain stimulation - are of limited effectiveness or cannot be used in all sufferers, and some have significant risks and side effects. The new treatment, MRI-guided focused ultrasound, is being used for essential tremor in a number of centres around the world and the first UK clinical trial took place at St Mary’s Hospital last year. It involves using real-time MRI imaging to focus ultrasound on a specific area of brain tissue. At that point, molecules are vibrated extremely quickly which creates intense local heat to destroy only the targeted tissue and break the abnormal electrical circuits causing the tremor.

In the St Mary’s trial - led by consultant radiologist Professor Wladyslaw Gedroyc, consultant neurologist Dr Peter Bain and consultant neurosurgeon Mr Dipankar Nandi - the procedure was used to treat 13 patients. Results have been very promising so far, with an average 70 per cent reduction in tremor symptoms. The full results of the trial are expected to be published later this year.

The NICE recommendation comes at the same time as Imperial Health Charity launches its Tremor Lifeline Appeal to support further research and to help the Trust gear up to providing the treatment on a larger scale. The appeal aims to raise £1.5 million to fund an additional MRI scanner at St Mary’s plus the costs of installation and improvements to patient waiting areas at the hospital's acute imaging centre.

Professor Wladyslaw Gedroyc said: “We welcome the updated guidance from NICE. This is a positive step forward in allowing more patients with essential tremor to have access to this life-changing treatment.

“We’re also very grateful to Imperial Health Charity for their initial grant which allowed us to buy the focused ultrasound brain hardware and also for their continued support in our ambition to set up a dedicated focused ultrasound centre to allow us to continue and expand our work in this field.”

The updated guidance, published by NICE on 20 June, recommends MRI-guided focused ultrasound to treat essential tremor provided there are special arrangements for clinical governance and patient consent, and that outcomes are audited and recorded to help with assessment of its long term effectiveness.

The Imperial College Healthcare team are also exploring how the procedure could be used to treat other brain disorders, starting with Parkinson’s disease. In the future, it may also be used to treat tumours, epilepsy and perhaps dementia.

The current essential tremor trial at St Mary’s is now closed. We are now awaiting NHS England’s decision on NHS patients; therefore this treatment is currently available only via Imperial Private Healthcare. More information is available here.