'I slur a bit, but if that's the only side effect I couldn't care less': Man, 74, has Gamma Knife radiation therapy that cuts into your brain to stop limbs shaking
- Around 65,000 people in UK have an essential tremor: uncontrollable shakes
- Everyday tasks are difficult, but Gamma Knife radiation therapy can cure it
- Roy Le Croissette, 74, from Eastbourne underwent the procedure
Around 650,000 people in Britain have essential tremor, an uncontrollable shake that makes everyday tasks difficult. But a form of radiation therapy can resolve the problem. Retired civil servant Roy Le Croissette, 74, from Eastbourne, East Sussex, underwent the procedure, as he tells DIANA PILKINGTON.
Tremor runs in my family. My grandfather and my mother had it, and I first noticed mine aged nine. I loved wood (my other grandfather was from a line of cabinet makers), but I couldn’t use a chisel without my right hand shaking.
As I got older it got worse. Teachers said my essays were spoilt by my appalling handwriting. And I even considered giving away my treasured stamp collection because I couldn’t pick them up with tweezers.
Brain scan: A coloured Magnetic Resonance Imaging (MRI) scan through a human head, showing a healthy brain in side view. Gamma Knife is a radiation device. It's called radiosurgery, because of it's focus on very high intensity radiation on a tiny area, aiming to destroy it. It's specifically designed for the head
Everyday tasks were problematic. When carrying tea I’d do the ‘teacup tango’ — it would bounce in its saucer and spill out — and doing up buttons took all my patience. And when out for a meal, if I wanted soup I sometimes had to get on my knees to drink it.
My wife was wonderfully supportive and I managed to work, but it was frustrating. I couldn’t take the minutes of a meeting because my writing was illegible.
I spoke to my GP at intervals but was always told I’d get used to it.
Finally I decided enough was enough, and I was referred to Professor Marwan Hariz at the National Hospital for Neurology and Neurosurgery in London in 2010.
I was told I could have been a good candidate for deep brain stimulation, where they use electrodes to stimulate the area of your brain responsible for tremor, but because I’d had a stroke in 2008 and was on the blood-thinner warfarin, there was a risk I could bleed to death, as it involves putting a metal probe in the brain.
There was another option: Gamma Knife, which delivers radiation to the brain, would effectively burn out the bit of it that controlled the shakes. I was warned that there might be side-effects — such as speech difficulty, or limbs not functioning as well as before — but I thought it worth the risk.
Unfortunately, I couldn’t get the treatment on the NHS, so my colleagues in the Freemasons helped me get funding through their charity to have it at the Bupa Cromwell Hospital. I was over the moon.
A patient undergoing Gamma Knife. The treatment can get rid of essential tremor completely, but patients could possibly develop more tremor at a later stage
The procedure was scheduled for September 2012, under neurosurgeon Christer Lindquist. They began by measuring me up for a frame, which would be screwed into my skull to keep my head in place. It was a bit like wearing a TV screen on my head.
After having two scans of my brain, I lay on a table with the frame on my head, and was slid into the Gamma Knife machine. I’d brought some music to listen to, and shut my eyes. There was no pain, just a loud clanging. It took about two hours and I think I even fell asleep.
When I came out, the professor took the frame off and asked me to touch my fingers together. He nearly fell over at how easily I did it.
But it was six months before I noticed the major differences. Now I can write beautifully and do carpentry, whereas before I’d have lost a finger. I slur a bit now, but if that’s the only side-effect, I couldn’t care less.
Professor Christer Lindquist is a consultant neurosurgeon at the Bupa Cromwell Hospital, London. He says:
ESSENTIAL tremor runs in families but the exact cause is unknown. It’s degenerative, so it comes with age. In people with tremor, the nerve cells in an area of the thalamus, the part of the brain that controls movement, are firing in an abnormal pattern.
Professor Christer Lindquist, pictured here, is a consultant neurosurgeon at the Bupa Cromwell Hospital, London. 'As far as I am aware, I'm the only surgeon in the country to use Gamma Knife to treat tremor,' he said
Beta-blockers can be effective, perhaps because they block brain chemicals involved in tremor. Alcohol can also have a pronounced effect. My father-in-law had the condition and was very steady with a glass of whisky in his hand.
Surgery is only necessary when it becomes a real social problem or affects daily life.
There are three main surgical options. One is to put an electrode in the brain and use radiofrequency to heat the tissue and destroy the ventral intermediate nucleus (VIM), the pea-sized area in the thalamus responsible for the shakes.
You can also use deep brain stimulation, where electrodes stimulate the nerve cells in the VIM to block their activity.
But both methods are invasive, risking bleeding and infection, and with deep brain stimulation patients must carry a battery around for the rest of their life. Moreover, they are not suitable for patients on blood-thinning drugs.
As far as I’m aware, I’m the only surgeon in the country to use Gamma Knife to treat tremor. I started using it in 1985.
Knife is a radiation device. We call the treatment radiosurgery,
because we’re focusing very high intensity radiation on a tiny area,
aiming to destroy it. It’s specifically designed for the head: most
commonly for brain tumours, but also for facial pain and for cutting off
the blood supply to vascular malformations.
We give the patient a light sedative, then inject local anaesthetic into four points on their head so we can fix an aluminium frame into it (there may be light bleeding when it is removed later).
We then place a Perspex cube over the top of the frame and carry out an MRI scan. This cube has coordinates on it, so a computer can work out exactly where our target is.
We then fix the head frame to the couch that goes inside the Gamma Knife, so the thalamus is right at the device’s centre. Once we turn it on, 192 beams of radiation converge on the target. Each beam is quite weak, sparing healthy tissue. The radiation only becomes toxic where all the beams meet.
There is a risk of slight swelling from the radiation causing weakness in the area of the body where the tremor was. It could also cause speech difficulties, because the nerve cells affecting muscles involved in speech are close to the VIM.
The treatment can get rid of the tremor completely, but patients could possibly develop more tremor at a later stage.
We’ve treated about ten tremor patients here with Gamma Knife since 1998. In Britain it’s mainly used on patients who are not suitable for deep brain stimulation, but in other countries it is a primary procedure. A recent large study in Japan showed the two procedures had similar outcomes.
Gamma Knife radiosurgery is only available on the NHS in exceptional circumstances. But the committee that advises the NHS has proposed that it should be available.
The procedure costs around £15,000 privately, and could cost the NHS around £8,000.