Featured Post from ChristianaCare

First in Delaware to Offer MR-Guided Ultrasound for Treatment of Essential and Parkinson’s Tremor

Jun 19, 2024

3 min

Justin Martello, M.D.

Revolutionary technology gives patients immediate relief from debilitating tremors without the need for invasive surgery.


ChristianaCare is the first health care provider in Delaware to offer FDA-approved focused ultrasound treatment for people suffering from essential tremor and Parkinson’s disease.


The new option – called MR-guided focused ultrasound – uses sound wave energy to destroy precise areas of brain tissue that is the source of the tremor. No surgical incision or anesthesia is necessary, and many patients experience immediate and significant reduction in tremors, which can make daily activities challenging.


Dr. Martello explains that the procedure involves the use of high-frequency sound waves directed with pinpoint precision by magnetic resonance imaging to ablate, or burn, the focal point deep within the brain that is causing tremors.

“This minimally invasive technology dramatically improves the lives of patients with essential tremor and tremor-dominant Parkinson’s who haven’t fully responded to traditional treatments,’’ said Justin Martello, M.D., director of the Parkinson’s and Movement Disorders Programs, and Focused Ultrasound Program at ChristianaCare.


What is tremor?


Tremor is a neurological condition that includes involuntary shaking or trembling movements in one or more parts of the body. It most commonly affects the hands and can make daily tasks such as writing, eating and using a computer or phone extremely difficult.


Tremor affects approximately 1% of the population overall and 5% of adults age 60+. It is expected to increasingly impact Delawareans as the state’s population ages.


Essential tremor is the most common type of tremor. It can occur at any age but is most common in older adults.


Tremor is also the most well-known symptom of Parkinson’s disease. An estimated 1.5 million Americans suffer from Parkinson’s disease, a progressive neurodegenerative disease that affects movement and can also affect speech, balance and cognitive function.


A newer, better option for patients who don’t respond to medications


The procedure of MR-guided focused ultrasound involves the use of high-frequency sound waves directed with pinpoint precision by magnetic resonance imaging to ablate, or burn, the focal point deep within the brain that is causing tremors. Patients are fitted with a frame affixed to a specialized helmet that combines the focused energy of more than 1,000 high-frequency sonic beams directed through the skull.


The treatment does not require cutting through the skull, or radiation, as in gamma knife technology.


“Today, there are basically three options for managing tremor,” said Pulak Ray, M.D., of Delaware Neurosurgical Group and associate director of the Focused Ultrasound program. “The first is medication, which is effective and affordable for many patients, but its effectiveness tends to diminish over time. The second is deep-brain stimulation, which is the most invasive and costly treatment option. The newest is MR-guided ultrasound, which tends to be the preferable option for most patients who do not respond well to medication, because it is a simple, non-invasive outpatient procedure that is highly effective, safe and produces instant results.”


Benefits of MR-guided Focused Ultrasound


  • MR-guided focused ultrasound reduces tremor immediately, with shorter recovery time, lower risk of side effects and lower associated health care expenses compared to surgical alternatives.
  • This treatment dramatically improves patient experience and quality of life for people with Parkinson’s disease or essential tremor.
  • For many patients, MR-guided ultrasound reduces their dependence on caregivers to assist with activities of daily living.


Candidates must first undergo a CT scan to ensure a skull density sufficiently thick to accommodate the procedure.


The patient is awake during the procedure and situated within an MRI machine for real-time imaging of the brain.


The physician tests the precise location by heating the area, then ensuring the patient is able to control tremors by tracing lines on a spirograph. At that point, the physician then permanently ablates the focal point, usually a sphere a few millimeters in length.


“Our team is very excited to bring this technology to Delaware and to open up access to potentially life-changing treatment that until now has required long wait times and significant travel for patients,” said Kim Gannon, M.D., Ph.D., medical director of the comprehensive stroke program and physician executive of Neuroscience Service Line at ChristianaCare. “Many tremor patients have suffered for years or even decades with this debilitating and progressive condition and helping them live a more active and independent lifestyle is extremely rewarding.”


MR-guided focused ultrasound is covered by Medicare and most insurance plans.

Connect with:
Justin Martello, M.D.

Justin Martello, M.D.

Parkinson's and Movement Disorders Director

Dr. Martello, Delaware's only Parkinson's and movement disorders specialist, has established a comprehensive Parkinson's disease program.

Quality ImprovementParkinson's DiseaseNeurologyMovement Disorders

You might also like...

Check out some other posts from ChristianaCare

3 min

Three ChristianaCare Intensive Care Units Receive the Beacon Award for Excellence from the American Association of Critical-Care Nurses

ChristianaCare has once again been recognized by the American Association of Critical-Care Nurses (AACN) for its exceptional complex care. The AACN has awarded the Beacon Award for Excellence to three intensive care units at Christiana Hospital in Newark, Delaware: the Medical Intensive Care Unit (MICU), the Surgical Critical Care Complex (SCCC), and the Transitional Surgical Unit (TSU) Beacon Awards honor critical-care nursing units that demonstrate exceptional patient care, improved patient health outcomes, a supportive work environment and opportunities for collaboration. The Beacon Award is widely considered to be the most prestigious award in critical-care nursing. “The Beacon Award shines a light on individual nursing units for their commitment to providing critically ill patients with exceptional care and evidence-based practices,” said Danielle Weber, DNP, MSM, RN-BC, NEA-BC, chief nurse executive at ChristianaCare. “These awards reflect nursing excellence and commitment to exceptional health outcomes, an outstanding work environment and superior patient experience.” AACN President Jennifer Adamski, DNP, APRN, ACNP-BC, CCRN, FCCM, applauds the commitment of the caregivers at ChristianaCare for working together to meet and exceed the high standards set forth by the Beacon Award for Excellence. These dedicated healthcare professionals join other members of our exceptional community of nurses, who set the standard for optimal patient care. “The Beacon Award for Excellence recognizes caregivers in outstanding units whose consistent and systematic approach to evidence-based care optimizes patient outcomes. Units that receive this national recognition serve as role models to others on their journey to excellent patient and family care,” Adamski said. Consecutive successes Each of these units has received multiple Beacon Awards. • The MICU has been continuously recognized as a Beacon unit since 2009. It is the sixth time that the MICU—Delaware’s first Beacon Award-winning unit—has received the national award, with four silver and two gold recognitions. The unit holds the most Beacon Awards in Delaware. • The SCCC received a silver-level award for the fourth time. • The TSU received a gold-level award for the first time, after receiving two silver-level awards. “For us to be designated for such a consecutive amount of time is a testament to the ongoing, intensive work that we do and the focus on excellence that we have,” said Carol Ritter, MSN, RN, CCRN, CNML, nurse manager for the MICU. “It’s an affirmation of the care that the nurses provide and the excellence that they bring every day, using advanced protocols and the latest technology and research.” Beacon-designated units are renowned for their healthy work environments and high morale, which results in strong relationships among the nurses and outstanding patient care. “Our nurses are committed to providing exceptional care and patient outcomes,” said Amanda Latina, MSN, MBA, RN, TCRN, nurse manager of the TSU and SCCC. “They embody what it means to be a critical-care nurse.” Of the seven Beacon Award-winning patient care units currently in Delaware, all are at Christiana Hospital in Newark. These include the Neuro Critical Care Unit (silver), the Cardiovascular Stepdown Unit 4E (silver), the Cardiovascular Critical Care Complex (three-time gold winner), the Transitional Medical Unit and the 3C Intermediate Medical Unit (both silver).

4 min

ChristianaCare Charts New Course With Nurse Robotics Research Fellowship

ChristianaCare, the first hospital system in the region to deploy collaborative robots, has once again broken new ground, this time with a nationally unique initiative that puts bedside nurses at the helm of robotics research and innovation. At a graduation ceremony April 30, ChristianaCare celebrated the first four clinical nurses completing the Nursing Research Fellowship in Robotics and Innovation — the first program of its kind in the nation. The fellowship was part of a larger three-year, $1.5 million grant from the American Nurses Foundation’s Reimagining Nursing Initiative. The grant supports ChristianaCare’s broader study on how collaborative robots impact nursing practice. Over eight months, nurses from different units and specialties participated in immersive research training and lectures designed to expand their knowledge, curiosity and professional growth. Their work culminated in national conference presentations and preparations for journal submissions. The inaugural Nursing Research Fellows in Robotics and Innovation are: Briana Abernathy, BSN, RN, CEN – case management, Christiana Hospital emergency department Elizabeth Mitchell, BSN, RN-BC – Christiana Hospital surgical stepdown unit Hannah Rackie, BSN, RN, C-EFM – Union Hospital maternity unit Morgan Tallo, BSN, RN, CCRN – Christiana Hospital cardiovascular critical care unit A ‘real seat at the table’ “When you create programs that empower nurses to lead, innovate and tackle meaningful challenges, you see real impact — not just in new skills and knowledge, but in job satisfaction, well-being and retention,” said Susan Smith Birkhoff, Ph.D., RN, program director of Technology Research & Education at ChristianaCare. “This fellowship is built on the belief that when nurses are given the space to learn and lead, they bring fresh ideas and collaborative solutions back to their clinical practice areas.” Created and led by Smith Birkhoff, the fellowship is a standout in the U.S. health care landscape: It gives bedside nurses the chance to step away from their daily routines and gain advanced research experience, an opportunity rarely available at the clinical level. While the fellowship directly trained four nurses, its reach extended well beyond thazt. Fellows shared what they were learning along the way, sparking wider interest in research across the health system. The research program was highlighted as a new knowledge and innovation exemplar in the latest evaluation by the American Nurses Credentialing Center, which in March awarded ChristianaCare its fourth Magnet designation — the gold standard for nursing excellence. Adriane Griffen, DrPH, MPH, MCHES, vice president of programs at the American Nurses Foundation, praised ChristianaCare’s responsiveness in shaping the program around nurses’ needs and building a model for future innovation. “What makes this fellowship stand out is its focus on giving bedside nurses a real seat at the table,” Griffen said. “When nurses are trusted to lead and have the right support, they develop solutions that are practical, sustainable and transformative. This fellowship shows how nurse-led innovation can grow from a local pilot into a model for improving care across the country.” Through the fellowship, nurses gained a deeper understanding of applying research methodology to advance robotics science at the intersection of nursing and hospital operations, which is groundbreaking and novel. “This is such an exciting and important moment for our profession,” said Danielle Weber, DNP, RN, NEA-BC, chief nurse executive at ChristianaCare. “Innovation is about improving care, easing the burdens on our teams and finding smarter ways to meet the complex needs of our patients. Tools like collaborative robots don’t replace the human touch, they help protect and elevate it.” Mitchell said she was initially intimidated when she saw the fellowship application because it had been years since she last engaged in formal research. Learning everything from literature reviews to abstract writing pushed her outside her comfort zone and gave her practical tools to take new ideas forward. The experience inspired her to return to school this fall to pursue a graduate degree. A ‘ripple effect’ “This fellowship reignited my enthusiasm for learning and gave me the skills and confidence to keep growing,” Mitchell said. “It’s been amazing to collaborate with other fellows and mentors, and I’m excited to apply what I’ve learned to improve patient care and strengthen our teams.” In addition to Smith Birkhoff, Kate Shady, Ph.D., RN, OCN, RN IV, served as a mentor to the fellows, bringing expertise from her hematology/oncology background. Kati Patel, MPH, provided key administrative coordination and support throughout the program. ChristianaCare continues its broader research into robotics integration, with findings from the multi-year collaborative robot study expected to be shared later this year. Shady said the fellowship is already influencing ChristianaCare’s nursing culture by expanding interest in research and evidence-based practice well beyond the initial group. The program’s ripple effect is helping build lasting infrastructure for nurse-led innovation across departments. “One of the most rewarding parts of this fellowship has been seeing these nurses step into new confidence and capability,” Shady said. “They began unsure about research, but by the end, they were reading studies, writing abstracts and mentoring peers — laying the groundwork for bigger change in how we advance nursing practice.” Learn more about nursing at ChristianaCare.

2 min

Vishesh Agarwal, M.D., Appointed Chief of Addiction Medicine Services

Vishesh Agarwal, M.D., has been appointed chief of Addiction Medicine Services at ChristianaCare. In this role, Agarwal will lead and expand ChristianaCare’s comprehensive addiction treatment services, guiding care for people with substance use disorders across inpatient, outpatient, emergency and consultation settings. He will oversee addiction programs across all campuses, help create consistent care guidelines and support teams of experts working together to provide safe, effective and compassionate care for patients. A key priority for Agarwal will be to explore strategic growth opportunities to broaden ChristianaCare’s reach and strengthen its impact on individuals and families affected by substance use disorders. His leadership will be instrumental in ensuring that ChristianaCare continues to set the standard for innovation and excellence. Agarwal will continue in his role as vice chair of the Department of Psychiatry at ChristianaCare, maintaining his leadership of clinical and operational initiatives in the Behavioral Health Service Line. He will continue to lead efforts to improve provider well-being, develop care pathways and foster clinical growth. He also oversees the Behavioral Health Unit, Emergency Department crisis services and psychiatric consultations for hospitalized patients. Agarwal is board certified in general adult psychiatry, addiction psychiatry and obesity medicine. He has published research on substance use and behavioral addictions in peer-reviewed journals and has presented at national conferences. His 2021 study linking gambling disorder, major depression and suicide risk was published in Addictive Behaviors and gained national attention. Agarwal holds an Executive MBA from Quantic School of Business and Technology and completed an addiction psychiatry fellowship at the Zucker Hillside Hospital. He completed his psychiatry residency and served as administrative chief resident at Einstein Medical Center. He earned his medical degree from Gauhati Medical College. Agarwal teaches and mentors psychiatry residents and medical students as a clinical assistant professor at Sidney Kimmel Medical College at Thomas Jefferson University. He also co-chairs system committees and serves on the board of the Mental Health Association in Delaware. He reports to Mustafa Mufti, M.D., chair of the Department of Psychiatry.

View all posts
Powered by