An Imaging Study for Detecting the Optimal Target ("Sweetspot") in Essential Tremor Patients Treated with Magnetic Resonance-guided High-Intensity Focused Ultrasound

Essential tremor is one of the most common movement disorders in our population (4-10%), with its prevalence increasing with age. A large portion of these patients (up to 50%) can be refractory to medical therapies, and the tremor is so limiting that it severely interferes with daily activities.

A brain lesion in the thalamus (thalamotomy), specifically in the ventral intermediate nucleus, has traditionally been an effective surgical treatment. However, this technique lost popularity over the years due to being highly invasive and not widely known.

Currently, the emergence of a new technology called magnetic resonance-guided focused ultrasound (MRgFUS) is allowing for the creation of millimeter-precise and extremely accurate lesions using high-intensity ultrasound that passes through the skull. It is, therefore, a non-invasive and outpatient surgery (the patient goes home two hours after the procedure).

Given the novelty of this treatment, many groups are still studying which specific regions of the ventral intermediate nucleus of the thalamus should be lesioned to produce the best clinical improvement and avoid adverse effects of the therapy (e.g., oral paresthesia, gait instability).

In this project, the student will join our center's movement disorders group, where they will have the opportunity to interact with patients treated with this therapy. They will also collaborate with a wide range of professionals (neurologists, psychologists, neurosurgeons, bioengineers), with the possibility of assisting in these procedures. The computational work will require processing real brain images with specific software.

The student will have their own dedicated space in our research area, complete with a workstation and access to clinical image and signal data.

Important Warning

The clinical data used in this work is highly sensitive and protected by intellectual property. Consequently, it cannot be exported from the designated workstations. Any manipulation of this data outside the initial study protocol must be reported to the project supervisor and will be discussed on an individual basis.

Project Objective

To advance the knowledge of essential tremor, specifically its therapeutic target (the ventral intermediate nucleus of the thalamus). The goal is to identify the "sweetspot" (the region of maximum interest within the nucleus) for improving essential tremor, as well as the surrounding "sourspots" that produce adverse effects.

Necessary Computational Skills

For data analysis and the clinical reasoning behind it, the student will have close supervision and contact with our group's clinical-technical team.

  • Programming Languages: Python, MATLAB (basic-intermediate)

  • Data Analysis: Proficiency in statistical packages (Stata), image processing with Lead-DBS and SPM software, supervised machine learning (classification).

  • Simulation Tools: Simulink

  • Database Management: Excel, Stata

  • Other Specific Skills: Development and/or refinement of machine learning algorithms

Hosting group: Brain Neuromodulation Computational Lab.

Supervisors: Juan Aibar ([email protected]), Esther Granell