For the first time, Kentucky doctors perform new surgery for tremors, Parkinson's symptoms (2024)

This Thanksgiving, Pat Murphy is grateful for the steadyfood on his fork.

After 30 yearsof fighting tremors and enduring spills — the turkey, mashed potatoes and stuffing are finally going effortlessly into his mouth.

Two weeks ago, Pat had an incisionless surgery on his brain that eased the tremors in his right hand by at least 75%. For the past 30 years, the most trivialmotions in his dayrequired unfathomable patience. Essential tremor, a neurological disorder that causes involuntary shaking or trembling in certain parts of the body, runs in the Murphy family. As a young boy, Pat saw his father frustrated with an intense, involuntary shaking of his hands. By the time Pat turned 19, he noticed a decline in his fine motor skills, fumbling with the pens in his hands or placing golf tees on the green.

He watched his father live and die with tremors.

Until Pat heard about this new surgery, he suspected he would, too.

On Nov. 15, Pat became the first patient in Kentucky to be treated with focused ultrasound technology at the Norton Neuroscience Institute. The roughly two-hour procedure used ultrasound beams to create a lesion in the brain that relieved his tremors.

The technology, which was first approved by the Food and Drug Administration in 2016, can also ease tremors for people with Parkinson’s disease. Research and clinical trials are underway exploring how this relatively new technology can treat other neurological conditions, said Abigail Rao, the stereotactic and functional neurosurgeon who performed Pat’s surgery. The uses for focused ultrasound technology are being explored for "a massive variety of neurologic disorders," Rao said. Rao anticipates that in the next few years, this technology will allow Norton and other centers to treat more neurological conditions in new and better ways. The hospital system is about one of 75 other centers in the United States offering this technology and the first in Kentucky.

Essential tremor is a progressive condition that worsens as a patient ages, Rao explained. An estimated 6.4 million adults in the United States have essential tremor, according to a report published in 2020 in the Neurology Journals from the American Academy of Neurology.

“Although it is not a life-threatening condition, it certainly can become more and more disabling,” Rao said.

Just weeks ago, involuntary movements in Pat’s hands controlled his day from the moment he woke up until he went to bed at night. His hands shook as he tried to put toothpaste on his brush, and then again, when he lifted it to his mouth to brush his teeth.

Buttoning his shirts was tedious. Pouring hot coffee from a traditional pot meant possibly missing his mug and singeing his hand.

Even writing words on paper has become increasingly difficult over the years, whether it’s an important legal document or something as simple as a grocery list.

His tremors usually only calmed while he relaxed in front of thetelevision, but started again as soon as he reached for the remote or something to drink.

“I see the frustration,” his wife, Diane Murphy, told The Courier Journal, in the days before his surgery. “It’s just slowly gotten to where he can’t do things, or it’s just easier if I do things for him because he might spill it.” 

Cutting a steak atdinner with a client was borderline impossible. Holding a plate and serving himself in a buffet line was a social nightmare.Every bite he took during every meal involved thoughtful effort.

Many of those morsels missed his mouth altogether, and the misfires smeared his face with food or stained his clothes.

“I would be conscious about how much it was noticeable,” he said. “And then as soon as you think about it, it gets 10 times worse.”

Treating essential tremor with incisionless brain surgery

About half the people with essential tremor inherited the condition from a parent. Over the years, Pat has apologized to his daughter for unwittingly passing it down to her. His sister, brother, and nephew all have tremors, too, meaning Pat has plenty of family members with which to swap horror stories. Sometimes laughing together is the only thing the Murphys can do to get through the trying moments.

He recalled a trip to a Bass Pro Shopthat still haunts him. Once he went to pick up an order, and the clerk asked him to re-type all his information into the store’s system. He’d been careful to do that at home to avoid any chaos, but the employee insisted he still had to fill out the forms.

Every letter was a struggle, so much so, that he called his wifein a panic.

“I can’t do this,” he told her, horrified.

She encouraged him to keep going and reminded him he’d likely never see those workers again.

Pat was eager to put situations like that behind him. That’s part of the reason he was first in line and the self-proclaimed "guinea pig" for his family when Norton began offering the surgery this month. Tremors had disrupted his life for far too long, and he hoped that if the procedure worked well for him, it could help his daughter, sister, brother, and nephew, too.

The procedure sounds like something from a sci-fi movie, but it’s been gaining popularity and improving tremors in patients, with minimal side effects, for about six years.

“We've had surgical treatments in the world of neurosurgery for quite a long time for (tremors), but focused ultrasound is an exciting new surgical treatment because it gives us the ability to improve the tremor in a minimally invasive way but also a testable and immediate way,” Rao explained.

Throughout the surgery, several ultrasound beams carefully create a small lesion in a specific part of the brain. The patient wears a helmet-like device filled with cool water that has more than 1,000 ultrasound transmitters. All the while, Rao tests the patient’s tremor and neurologic function, and an MRI scanner monitors the location, size, and temperature of the lesion being created.

It’s all done with several clicks of a computer mouse, and it never involves a scalpel.

Only one-half of the brain undergoes the treatment at a time to minimize potential side effects such as balance trouble,speech changes, and sensation changes. In Pat's case, that meant that calming the tremors on the left side of his body would have to wait until 2025.

Patients stay awake throughout the entire procedure so Rao can measure tremor improvements between each scan. One of the most difficult movements for a person who has tremors is drawing a spiral on a sheet of paper.Rao adjusts the ultrasound beams, until the patient’s hand increasingly steadies. If everything goes according to plan, the spiral improves from a forced jerky squiggle to a single smooth stroke.

'You have changed our lives'

On the morning of Pat’s surgery, he stepped into the MRI suite at Norton Brownsboro Hospital with a freshly shaved head. He knew doctors needed a smooth surface for the procedure, so he figured he’d give them a head start.

The staff numbed a couple points around his scalp and slowly screwed in and strapped on the helmet. They handed him a sheet of paper and Pat drew two spirals and three straight lines. At the bottom, he signed his name.

Try as he might he couldn’t steady his hand, and the pen jerked awkwardly with each smudge of ink.

It looked like he’d been writing during an earthquake.

Just before 9:20 a.m., Pat laid down on the MRI table and the team wrapped him in warm blankets. Once he was snug and secured in the scanner, Rao took her position in front of the computer screen, where she'd calculate how to direct the machine, take baseline images, and create test lesions in the brain.

Around 10:15 a.m., they rolled him back out and handed him a clipboard with that same spiral test he'd taken before. A curious excitement simmered throughout the room, as the team passed the sheet of paper from hand to hand. Rao speculated the tremors had improved by nearly 25%.

That was an encouraging start.

Over the next hour, those spirals improved ever so slightly with each scan. Out in the waiting area, Pat's wife, brother, and sister-in-law stared down at the test sheets marveling at the steady improvement, until finally, Rao declared they’d reached about 75%.

So, Rao's team rolled Pat back out from the MRI, unwrapped him from the blankets, and helped him to his feet. Mere minutes after Rao created that lesion in his brain, Pat walked out of the MRI room and settled into a chair.

He drew two clear spirals, three more lines and signed his name without much difficulty.

He hadn’t seen his signature look that clear in decades.

Before they’d left the house that morning, Pat’s hand bungled through one final, wobbling bite of a powder-sugar donut at breakfast, and by lunchtime, he was holding a water cup and sipping without any difficulty at all.

Rao asked Pat to bring both of his pointer fingers together, and the right hand held steady while the left one still quaked. It was a wild reminder of just how much had changed on the right side of his body that morning.His wife, brother, and sister-in-law all stared dumbfounded at his right hand, as he held it nearly motionless in front of his face.

By Thanksgiving 2025, Pat expects he’ll be able to hold both a fork and knife steady at the same time. His motions may not be the only ones that improve around the dinner table, either. Now that he’s been the “guinea pig,” he imagines the rest of his family members with essential tremor might give it a try, too. In the days following the procedure, Pat said he believed the lesion had relieved his tremor by as much as 90%.

But those first moments after he stepped out of the MRI machine were less about numbers and estimates, and more about gratitude.

“I’m happy,” Patrick told the hospital staff kindly and simply, as his wife’s eyes welled with tears.

“You have changed our lives,” she gratefully told Rao, gazing at Pat’s steady hand. “That’s crazy. Just crazy.”

Reach reporter Maggie Menderski at mmenderski@courier-journal.com.