In the latest episode of the program “Doctor I…” from September 20, 2022, the first Russian MRgFUS neurosurgeon Rezida Maratovna Galimova
Today we are excited to present an engaging discussion centered on the treatment of cervical dystonia. This topic has caught our attention for a reason: in the past, we became pioneers in the use of MRI-guided focused ultrasound for the treatment of movement disorders
Cervical dystonia, also known as “torticollis “, for centuries was an unsolvable problem for doctors. However, today, thanks to innovative techniques and the development of research, we are one step closer to ensuring a healthy and comfortable life for everyone. In this episode of the program “Doctor I…”, neurosurgeon Rezida Galimova will talk about modern methods that help patients gain freedom from this disease.
The focus is particularly on focused ultrasound — a technology that has already proven itself in our clinic as an effective method. Rezida Galimova, with her team, is turning the dream of painless and precise treatment into reality.
Let’s embark on this inspiring journey together to new heights in medicine, and perhaps we can see beyond the horizon a shared dream of a world where medicine is safe, humane, and successful.
Irina Pershina: In antiquity, cervical dystonia was described as «”stiff neck syndrome.” At that time, the only method of treatment there was cutting of muscles and tendons. Of course, this method did not solve the problem and was terribly dangerous. What modern treatment methods are used today? And will they help the patient get rid of this disease forever? Let’s discuss. Today we have a neurosurgeon, PhD, as our guest – Rezida Galimova. Good morning!
Rezida Galimova : Good morning, hello!
Irina Pershina: What is cervical dystonia why is this disease also commonly called torticollis?
Rezida Galimova: The basis of this disease is a disruption of the impulses sent from the brain to the neck muscles or other trunk muscles. And when these impulses are sent uncoordinatedly – there is multidirectional muscle work, leading to head turns – to hyperkinesis, such as we call them, involuntary movements from the head. And therefore, it is often popularly called spasmodic torticollis because they see spasticity from certain muscles, they see torticollis, which is why the synonym “spasmodic torticollis” has formed
Kirill Radzig : At what age is this usually begins and who suffers more from it: men or women?
Rezida Galimova : For dystonia there is no specific age. There are children in whom we observe cervical dystonia or other forms dystonia. Of course, Bloom – it’s 30-60 years, but it should not be ruled out that this disease и occurs in children and gradually develops. The feature of the disease is that in women this is observed much more frequently. A lot of genes have currently been identified Groups DYT, which are detected in certain forms of dystonia. Therefore, now the attitude towards dystonia has somewhat changed with the development of genetics: the disease more often associated with genetic pathology
Irina Pershina: How does this disease start and progress?
Rezida Galimova : Each patient describes the onset of the disease in their own unique way. Many patients such disease symptoms there is even in childhood. Some have tics, some have squinting, “sniffing,” shoulder shrugging. Then adults forget these symptoms. And in adulthood one of the very first symptoms is appearance of muscle sensation either on the right or on the left on the left. They clearly say: “I started feel the muscle”, “I started feeling tension in this muscle” This may appear suddenly or when performing certain actions. Over time, muscle tension increases, leading to twisting or tilting heads may appear. May appear movements, we call them hyperkinesias. Some call it tremor or tremor, that is, turning of the head. To the right, left, forward, or backward.
Irina Pershina: Hyperkinesias can vary. From What does this diversity depend on? Is there a clear characteristic of who has which hyperkinesias can they be?
Rezida Galimova : We distinguish different forms of hyperkinesias. When we observe the head turning to the right or left, it is called torticollis. When turns with a slight tilt to the right or left, we call it Laterocollis. And, naturally, when a person tilts their head forward – this is anterocollis, backward – Retrocullis.
Irina Pershina: Does it depend on the foci of the impaired neurons, am I understanding correctly? On the location where they disrupt their function?
Rezida Galimova : Most likely, the genetic disorders we find in patients encode transmission impairment neurotransmitters
Irina Pershina: Here in certain places?
Rezida Galimova : Yes, in certain places. And these neurotransmitters are directed differently and regulate these impulses At the base of the brain – basal ganglia extrapyramidal system. And depending on where it occurred, we see different muscle groups in our patients.
Kirill Радциг : Can these movements be controlled?
Rezida Galimova : At the first stage, many patients do indeed control these movements.
Irina Pershina: So, somehow by willpower, right?
Rezida Galimova : Yes, they sometimes initially arise from some emotional excitement, surge. Then patients develop points, pressing on which they can stop the movement. Patients find these points in an amazing way because they start pressing and suddenly find a point that stops the forward movement of the head. These points we called in neurology «”zero points” since they «reset these movements. In addition, patients always try to make some corrective movements, support their head. At most often during my consultations, patients sit and hold their head with both hands. That is, indeed, if they fix the back of the head to the chair, if they support head, if they make some tilts, then these hyperkinesias or tremors may decrease or almost disappear
Irina Pershina: I know that there are several methods for treating this disease. Could you please tell us about them
Rezida Galimova : Currently, we categorize all treatment methods into conservative and surgical methods. Conservative methods – this is drug therapy, in case of dystonias – botulinum therapy Conservative treatment therapy with medications includes various drugs aimed at reducing either the emotional background the patient, or to reduce these movements, to relax muscles. Unfortunately, data medications have many side effects: drowsiness, development of dependence. Therefore, patients are recommended to definitely add therapy to the treatment of cervical dystonia botulinum, or botulinum toxin, when the doctor selects specific muscles, and into the muscles where noted spasticity, where we see by means electroneuromyography increased activity, entered given toxin And this leads to muscle relaxation, and these movements simply disappear The effect of this therapy lasts from 6 to 9 months. However, unfortunately, the human body has a unique characteristic – it can develop a tolerance to the toxin, begins to produce antibodies and stops responding to it And at the moment when the patient stops responding to botulinum therapy (after 5-6 therapies) – this is the moment when you need to think about surgery. Surgical methods are divided into surgical and non-surgical, for example, like our focused ultrasound.
Irina Pershina: About this method please tell me Read more.
Rezida Galimova : MRI-guided focused ultrasound allows a neurosurgeon to penetrate the brain through the skin, subcutaneous tissue, and bones и «Remove Plot brain, where these neurons «sit and produce this impulse We are just technically «remove this area, and these pathological impulses cease apply. And the patient experiences a reduction in symptoms clinical presentation
Irina Pershina: How do you find these specific areas in the human brain?
Rezida Galimova : Unfortunately, modern MRI development does not allow us to see these areas, but we we assume approximately where they can be localized We know theoretically and calculate mathematically where this area is located in this patient. The feature of focused ultrasound therapy is that we direct a certain amount of ultrasound beams, heat a specific area of the brain to a certain temperature, and observe the patient. If we see that hyperkinesias have decreased in the patient on the table after our preliminary treatment – means we «стоим» on the correct area, we are already conducting therapeutic sonication – ultrasound treatment and conduct monitoring already after treatment, and then we finish the procedure
Irina Pershina: Rezida Maratovna, thank you very much for your work, for restoring people’s health, and bringing them back to normal life. I really hope that our program currently viewed by those who who needs in your help, and they will definitely reach out to you
Rezida Galimova : Thank you!
Irina Pershina: Stay with us, we’ll be back after the break.
Video of results before and after ultrasound treatment of cervical dystonia
MRgFUS for Dystonias (Chapter of Our Research Monograph)
Mission and Vision of V.S. Buzaev International Medical Centre
Doctor - Obstetrician-Gynecologist, Ultrasound Diagnostics Doctor