Tag Archive for: high-intensity focused ultrasound

Doctors performing bilateral high intensity focused ultrasound (HIFU) pallidotomy on a patient with dyskinetic cerebral palsy.

Children’s National performs first ever HIFU procedure on patient with cerebral palsy

Doctors performing bilateral high intensity focused ultrasound (HIFU) pallidotomy on a patient with dyskinetic cerebral palsy.

HIFU is a non-invasive therapy that utilizes focused ultrasound waves to thermally ablate a focal area of tissue.

In January, a team of multidisciplinary doctors performed the first case in the world of using bilateral high intensity focused ultrasound (HIFU) pallidotomy on Jesus, a 22-year-old patient with dyskinetic cerebral palsy.

The procedure is part of a clinical trial led by Chima Oluigbo, M.D., pediatric neurosurgeon at Children’s National Hospital.

“The primary objective of the study is to evaluate the safety of ExAblate Transcranial MRgFUS as a tool for creating bilateral or unilateral lesions in the globus pallidus (GPi) in patients with treatment-refractory secondary dystonia due to dyskinetic cerebral palsy,” Dr. Oluigbo explained. “The secondary purpose is to assess the impact of HIFU pallidotomy on dyskinetic cerebral palsy movement disorder in pediatric and young adult patients.”

In addition, the impact of bilateral pallidotomy on motor development, pain perception, speech, memory, attention and cognition in these patients will be assessed.

“We hope that the trial will help us find results that lead to treatments that can reduce the rigidity and stiffness which occurs in cerebral palsy so we can help these children who do not have any effective treatment,” Dr. Oluigbo added.

“This new, first of its kind, non-invasive therapeutic approach – without even a skin incision – will open the door to offering hope for a number of kids with movement disorders who have failed conventional therapy,” said Robert Keating, M.D., chief of neurosurgery at Children’s National. “We are at the beginning of a new era for treating functional disorders in the pediatric patient.”

How it works

HIFU is a non-invasive therapy that utilizes focused ultrasound waves to thermally ablate a focal area of tissue. In the past, Children’s National successfully used HIFU to treat low-grade type tumors located in difficult locations of the brain, such as hypothalamic hamartomas and pilocytic astrocytoma, as well as for epilepsy and other movement disorders.

This most recent procedure was another successful milestone for the hospital, discharging Jesus the following day without any complications.

The team comprised neurosurgeons, MRI techs, anesthesiologists and radiologists, to name a few.

Originally, Jesus came to Children’s National in 2006 when he started working with the Physical Medicine and Rehabilitation team to help him with his muscle hypertonia management as well as equipment, orthoses and therapy concerns.

“As he continued to grow, his muscle hypertonia became more pronounced and caused difficulty with his care, positioning and comfort,” said Olga Morozova, M.D., pediatric rehabilitation specialist at Children’s National. “We have tried multiple oral medications however he has had significant side effects from the majority of the medications.”

Dr. Morozova and Julie Will, M.S.N., F.N.P., the nurse practitioner that worked with Jesus, referred him to Dr. Oluigbo after they learned about HIFU being an option to treat Jesus using a non-invasive approach.

Moving the field forward

This clinical trial highlights the expanding indications for focused ultrasound.

“We are excited about the potential for these innovative treatment strategies in neurosurgery to transform the lives of pediatric patients who suffer from challenging diseases, such as brain tumors, epilepsy, and movement disorders,” said Hasan Syed, M.D., co-director of the Focused Ultrasound Program at Children’s National. “We are redefining what is possible in neurosurgery.”

From low-intensity focused ultrasound (LIFU) treatments for our young DIPG patients to now the groundbreaking research on HIFU for pediatric movement disorders, the dedication to cutting-edge techniques highlights the team’s commitment to patients and transforming pediatric neurosurgical care.

MRI Room

Using high-intensity focused ultrasound to treat solid tumors

“I think high-intensity focused ultrasound is a really exciting technology that will allow for a different paradigm of how we think about treating solid tumors, both in a local and in a systemic way,” says AeRang Kim, M.D., oncologist at Children’s National Hospital. Dr. Kim explains high-intensity focused ultrasound (HIFU) and how she and her team have used this technology to treat pediatric solid tumors.

HIFU is energy that can be focused on any region of the body. It allows doctors to provide different types of energy in varying amounts, and it’s typically coupled with magnetic resonance imaging, which allows for precise, focused energy to specific areas with accuracy and temperature guidance.

Children’s National was one of the first pediatric centers to open a clinical trial for the treatment of pediatric solid tumors. Since then, we’ve opened several other clinical trials and combined them with targeted chemotherapy for the ablation of benign tumors and malignant solid tumors. We are one of the few institutions that have this study open and we are leading the clinical trials and coordinating them with other institutions across the country.

MRI Room

Children’s National uses HIFU to perform first ever non-invasive brain tumor procedure

MRI Room

Children’s National Hospital successfully performed the first-ever high-intensity focused ultrasound (HIFU) procedure on a pediatric patient with neurofibromatosis (NF). This is the youngest patient to undergo HIFU treatment in the world. Image provided by Insightec.

Children’s National Hospital successfully performed the first-ever high-intensity focused ultrasound (HIFU) procedure on a pediatric patient with neurofibromatosis (NF). This is the youngest patient to undergo HIFU treatment in the world. The advancement of children’s medical devices in the U.S. continues to significantly lag behind adult devices. This is why this milestone marks a significant advance in making pediatric surgery more precise and less invasive.

The hospital is offering this treatment to patients under an ongoing research clinical trial. Children’s National is one of the first pediatric hospitals in the nation to use HIFU for neuro-oncology patients. It’s also the first hospital in the world to use it to treat a pediatric patient with NF. NF is a condition that occurs in approximately 1 in 3,500 births and causes tumors to form in the brain, spinal cord and nerves.

“Using HIFU to treat our pediatric patients is a quantum leap towards non-invasive surgery for kids,” said Robert Keating, M.D., division chief of Neurosurgery and co-director of the HIFU program at Children’s National. “It’s exciting because the future is now here and it’s significantly better for our kids, in terms of non-invasive surgery with lower risk of complications and no exposure to radiation.”

Focused ultrasound (FUS) is a non-invasive therapeutic technology with the potential to transform the treatment of many medical disorders by using ultrasonic thermal energy to specifically target tissue deep in the body. The technology can treat without incisions or the need of radiation.

FUS, which has been used for adult clinical trials for many decades, can be delivered through high- or low-intensity focused ultrasound (LIFU). HIFU uses non-invasive therapy that uses focused ultrasound waves to thermally ablate a focal area of tissue. Children’s National will now use HIFU to treat low-grade type tumors located in difficult locations of the brain, such as hypothalamic hamartomas and pilocytic astrocytoma, as well as for movement disorders and epilepsy.

An alternative approach, LIFU uses lower levels of energy to disrupt the blood-brain barrier. Unlike medications, which often have difficulty crossing the blood-brain barrier, LIFU can transiently open the blood-brain barrier to chemotherapy. This may allow more effective treatment of tumors and offer opportunities to treat, for the first time, the entire extent of a malignant brain tumor.

“Having focused ultrasound technology as a tool and conducting clinical trials will allow our neurologists and oncologists to offer a non-invasive treatment option to many patients who suffer from neurological conditions,” said Hasan Syed, M.D., co-director of the HIFU program at Children’s National. “The milestone of performing this first HIFU procedure will lead the way to better understanding of the effect of this technology and provide patients with more options.”

At Children’s National, the HIFU program is being led by Dr. Keating and a multidisciplinary team, including clinicians and investigators from the Sheik Zayed Institute for Pediatric Innovation, radiology, oncology, surgery and orthopedics. In an effort to collaborate with the region’s adult hospitals, Children’s National will also treat adult patients on a selective basis who have movement disorders such as essential tremor and Parkinson’s. There is a scarcity of similar resources in the metro region. Many adult patients face one-year wait periods for treatment of their movement disorders, requiring many to travel out of state for treatment.

The LIFU program is scheduled to be operational in 2022. It will likely be the first in the U.S. to treat high-grade pediatric brain tumors with disruption of the blood-brain barrier and provide more effective routes for chemotherapy as well as potential immunotherapy and molecular approaches.

“The use of LIFU with microbubbles to open up the blood-brain barrier is an exciting, potentially game-changing approach for children with these tumors,” said Roger Packer, M.D., senior vice president of the Center for Neurosciences and Behavioral Medicine at Children’s National. “It should safely allow the blood-brain barrier to open and allow delivery of potentially life-saving personalized therapy to the tumor and spare the rest of the brain. It is the most exciting, new development in brain tumor therapy for these malignant midline tumors in the past 50 years.”

Children’s National continues to be a leader in pediatric HIFU use. In 2015, Children’s National doctors became the first in the U.S. to use MR-HIFU to treat pediatric osteoid osteoma – a benign, but painful bone tumor. Successful clinical trial results led to FDA approval in early 2021 for the use of the technology for this treatment. In 2020, the Focused Ultrasound Foundation also designated Children’s National as the first global pediatric Center of Excellence for using this technology to help patients with specific types of childhood tumors.

tumor cells

Promising new pediatric oncologic applications for focused ultrasound

tumor cells

Earlier this month, AeRang Kim, M.D., Ph.D., oncologist at Children’s National Hospital, spoke at the Focused Ultrasound Foundation’s 7th International Symposium on Focused Ultrasound about the latest developments in focused ultrasound applications for pediatric oncology.

Dr. Kim and a team of researchers at Children’s National belong to the IGNITE (image guided non-invasive therapeutic energy) team, a multidisciplinary group working to develop and transform focused ultrasound applications that will minimize treatment side effects and increase efficacy in pediatric cancer care.

In 2015, the IGNITE team conducted its first trial with a study of MR-guided high-intensity focused ultrasound (MR-HIFU) for treating painful osteoid osteomas (a benign bone tumor) in children. This was followed by a trial of MR-HIFU ablation for pediatric solid tumors.

“MR-HIFU has a potential role in local treatment of tumors, both benign and malignant,” Dr. Kim said. “What I’m most excited about is that MR-HIFU has the flexibility to be combined with other treatments such as heat sensitive targeted therapy and immune therapy. I believe this combination approach will have the highest impact in terms of safety and efficacy in pediatric cancer care.”

Aerang Kim

“MR-HIFU has a potential role in local treatment of tumors, both benign and malignant,” says AeRang Kim, M.D., Ph.D. “What I’m most excited about is that MR-HIFU has the flexibility to be combined with other treatments such as heat sensitive targeted therapy and immune therapy.”

Focused ultrasound is an emergent, non-invasive therapeutic technology that uses ultrasonic energy to target tissue deep in the body without incisions or radiation, thus resulting in minimal discomfort and few complications. This also allows for rapid patient recovery. The applications are wide-ranging: from thermal ablation of tumors and other lesions to blood-brain barrier opening, to increasing tumor vasculature for improved drug delivery, to augmenting immune response, among many others.

The team is now working on combinations of focused ultrasound with other therapies, such as chemotherapy. On the third clinical trial open for accrual at Children’s National, they combine MR-HIFU with lysothermosensitive liposomal doxorubicin, a heat-activated form of the cancer drug doxorubicin, to treat pediatric solid tumors. Although results are still preliminary, the hope is that the technology will mitigate some of the acute and late effects of current multimodal therapy in children. “We want to provide more efficacy and precision with these therapies,” said Dr. Kim.

In reflecting on the potential of this new approach, Dr. Kim believes the findings can help change the way experts think about cancer treatment.  The team is studying pre-clinical models of pediatric cancer to evaluate the different modalities of MR-HIFU with immune checkpoint inhibitors. Understanding that there are limitations of MR-HIFU ablation alone, Dr. Kim believes the future for most pediatric cancer applications will be combining approaches using the various bioeffects of focused ultrasound.

“We hope that if promising effects in multiple models utilizing this combination, we can translate these findings into the clinical setting,” she said, noting that the clinical trials led by her team are among the first in the U.S. of HIFU for children. “Children’s National is one of the first pediatrics centers to lead a HIFU program and the Focus Ultrasound Foundation’s first Center of Excellence focused exclusively in pediatrics.  We hope to continue to expand our findings and improve pediatric cancer care that’s more precise, less toxic, less invasive and pain free.”