Rezida Maratovna Galimova on the new method of treating tremor.
Automatic transcript:
Svetlana Valieva: For the first time in Russia and in Ufa, an innovative technology has been used to save patients from tremors in their hands and feet. Previously, such operations were only possible with skull opening and general anesthesia. Today, Ufa doctors perform this procedure even without incisions. This is the program “Vesti. Interview” and I am Svetlana Valieva. How did such a fantastic achievement become possible in Bashkiria? We decided to ask neurosurgeon Rezida Galimova. Rezida Maratovna, hello. Good afternoon.
It’s a pleasure to have you in our studio because you are a well-known figure not only in medicine but also, in my opinion, a great luminary. I’d like to start with the first question before we discuss what makes this method unique.
Svetlana Valieva: how are such breakthroughs in medicine possible during the coronavirus infection pandemic?
Rezida Galimova: coronavirus, on the contrary, contributed to it. Digital technologies, such innovative technologies made a breakthrough. If previously these technologies developed slowly, people kind of remembered them but developed at their own pace, then coronavirus spurred us all to live in a digital world, to transition to such innovative technologies. Our experience shows that, on the contrary, in terms of innovation development, medical advancement, and the development of new directions, there was significant pressure from coronavirus for this to happen.
Svetlana Valieva: that is, the coronavirus has become a stimulus for the development of specific fields in medicine, it turns out. And let’s return to the operation you perform, how unique is it. For me, when I found out, it was like science fiction, simply fantastic, some action described, perhaps, in a science fiction novel, that you can penetrate the human brain without cutting the head.
Rezida Galimova: actually, when you first read or watch a video of the surgery, some kind of cognitive dissonance arises
You don’t understand that there is a skull, there are bones, there is skin. And how to penetrate inside without cutting and without making trephination holes? I had a similar situation when I first saw this operation. And now it is possible because ultrasound can penetrate through the skin and bones. And when we use hundreds and hundreds of ultrasound waves, we can make them converge on one tiny point in the brain, somewhere deep, about 8 millimeters from the skull bone, and perform this operation. So it turns out that inside the brain, without cutting the person, we form a scalpel that is obedient, that moves inside the brain and does not cause any harm at the first stage of the operation, it is controllable. We can control the size of the impact, the degree of impact, and which part of the brain is affected.
Svetlana Valieva: why do such points form in a person’s brain that cause their hands and legs to start shaking?
Rezida Galimova: the development of diseases occurs in stages. We have control at the cortical level and control at the subcortical level. For example, in the development of tremor, such as in Parkinson’s disease, it involves the subcortex, the thalamus, and these nuclei go out of control, starting to act independently and send many impulses bypassing the cortex. As a result, the impulse moves through the base of the brain, and we observe the tremor in a person’s hand.
And we, as it were, working there in the thalamus, remove this relay station, and we turn off this pathological signal in a person that goes from the cortex to the thalamus and then to the hand. This allows us to control and eliminate the symptom of the disease, so that the person can return to their profession and become a fully functional, socially adapted individual.
Svetlana Valieva: who is most often affected by this ailment?
Rezida Galimova: with essential tremor, when there is only shaking, no stiffness – essential tremor occurs in both men and women. And my youngest patient is 7 years old, the oldest patient with essential tremor is 82 years old.
Svetlana Valieva: and it is passed in the family from parents to children. So, it’s a genetic factor, right?
Rezida Galimova: Yes. In the case of Parkinson’s disease, in addition to tremor, stiffness also joins as a symptom of the disease. In the case of our procedure, we eliminate both tremor and stiffness in the patient. Currently, there are many factors that contribute to the development of Parkinson’s disease. One is the genetic factor, as well as exposure to harmful chemical factors. Unfortunately, we do not yet know the others.
Svetlana Valieva: How else can it be applied, perhaps to other points and other diseases? Is this the future of this method?
Rezida Galimova: Absolutely, Svetlana, because there are, for example, dystonia disorders. It is different from essential tremor and Parkinson’s disease. In dystonia, we target a completely different area and deactivate another station. Imagine the brain as a neural network, with railway tracks running down from the cortex. At the base of the brain, there are relay stations where neurons sit, deciding whether to pass the impulse or not. Our task is to catch this group of neurons and tell them, guys, we no longer work with you. We essentially turn them off using ultrasound. The impulse stops being transmitted from the cortex to the limb, and all symptoms disappear.
Svetlana Valieva: Why did you start performing such a unique operation in Russia? Why did no one do it before? Is it because you are such an enthusiast? Because you find it interesting? Because it truly impressed you?
Rezida Galimova: when I first saw this surgery, I was really shocked because I had a childhood dream to do something without touching a person. In childhood, my dream was somewhat different. I then thought that I could take some small robot, create it and introduce it through a vessel. It would reach the brain and remove the tumor, then it would return.
Svetlana Valieva: Are such robots not available now?
Rezida Galimova: currently, there are no such robots, at that time I didn’t fully understand brain anatomy, that if it enters through a vessel, hemorrhage occurs. So, it’s still invasive. But when I saw focused ultrasound and how my colleague works…
Svetlana Valieva: Let’s explain to the audience what “invasive “– this is causing injury
Rezida Galimova: yes, this is an incision, this is the application of a trephination hole on the skull and the impact on the brain with instruments.
In our case, we enter the brain, work, but everything—skin, bones, and muscles—remains without incisions, untouched, intact.
Svetlana Valieva: Where did you see this for the first time?
Rezida Galimova: I first saw this in the United States of America when I was studying there, and I was inspired and thought that we deserve it, our patients deserve this method, because we should also have such a unique operation available for patients, and we can do it at the level of other countries.
Svetlana Valieva: how do patients feel about this procedure? Are they grateful, how many patients have undergone it, how many want to undergo it?
Rezida Galimova: There are certainly quite a few patients for whom this operation is indicated. For example, in Russia, there are about 5 million people with essential tremor. That is, those whose hands shake genetically, possibly even from childhood. Yes. And there are about 210,000 patients with Parkinson’s disease.
Currently, open surgeries also continue, and these operations are performed. That is, the duration of these surgeries is about 8-10 hours, with resuscitation, hospitalization, and drilling a hole in the skull.
Svetlana Valieva: do people agree to this?
Rezida Galimova: when people don’t know that there is a non-invasive surgery, that such possibilities exist, yes, they agree
Svetlana Valieva: So, it turns out you wanted to be a doctor since childhood and dreamed of delving into the brain. But as a neurosurgeon, you still perform surgeries, right?
Rezida Galimova: Yes, but when I saw this technique, I thought it was my childhood dream, already realized by engineers and research. And now it only depends on me how much energy, enthusiasm, and my desires I will invest to bring this technology to Russia, open a center, make it accessible, and help people feel how to fulfill a dream. That is, every patient has a dream, just like I do. They dream of coming in the morning, undergoing treatment without pain, without incisions, and leaving in the evening.
Svetlana Valieva: it’s really fantastic
Rezida Galimova: Yes, and now this is indeed happening because patients come to us in the morning, we perform a two-hour operation, and in the evening we discharge them.
Svetlana Valieva: Are there any other diseases that can be treated this way? Find points in the head that are responsible, so to speak, for the heart, liver, kidneys, and influence those points.
Rezida Galimova: I think it might be possible in the future. There is a lot of research going on right now, for example, on epilepsy. There are areas of the brain where we can also intervene, and the patient’s seizures will disappear.
There are tumors that are located in the median structures very, very deep, where a neurosurgeon cannot reach with ordinary instruments. Or he reaches them, but upon leaving, he leaves such damage that a person may have a limp arm or facial paresis. That is, focused ultrasound can remove such tumors that are located deep inside the brain, and this will be available in two to three years.
Svetlana Valieva: and, by the way, what is ultrasound? We are used to seeing ultrasound in a physiotherapy office, as some kind of device that, by the way, can even be at home. How is this ultrasound, which treats and seriously penetrates the brain, different?
Rezida Galimova: we have ultrasound, just like typical ultrasound. The creators of this equipment managed to make a helmet with many, many transmitters built in. So if we gather 1024 ultrasound devices in one place. In our helmet, there are 1024 ultrasound transmitters. These ultrasound transmitters are activated simultaneously, directing the beams where we need them and in the quantity we need. So it’s regular ultrasound.
Svetlana Valieva: that is, it’s fantastic because here physics has directly merged with medicine, yes, directly. We don’t have much time left until the end of the broadcast, and since we don’t often have a doctor on air, I would like to take advantage of the opportunity and ask, you know, we talked about the coronavirus at the beginning, and that measures are being followed, and now people are cautious about vaccination. So how correct is it to get vaccinated, and who needs to be vaccinated?
Rezida Galimova: Svetlana, as humanity, we have gone through epidemics many times, we went through the Spanish flu, smallpox, why? And each time the impact on or solution to the pandemic problem is standard. That is, we must create a layer of people in our population who are vaccinated, who can communicate, socialize, and it will be safe. Why do we practically not get measles, tetanus, diphtheria now? Because from childhood we are vaccinated, we have a vaccination schedule, and most of our population is vaccinated because we responsibly approach our personal health and the health of others.
As soon as the number of certain people in the unvaccinated population decreases, these infections emerge and start to play a major role. Just like we had a measles epidemic about two years ago. Parents refuse to vaccinate their children. There was such a trend among parents “we do not want to vaccinate children “. A large segment of unvaccinated children has emerged. And immediately, measles surfaced and caused a severe spike. The same applies in this situation: the more people we have vaccinated, especially the older generation, the less incidence we will encounter. And eventually, we will COVID will become a story like the Spanish flu, and we will remember it.
Svetlana Valieva: The Spanish flu, they say, went away on its own, meaning there was no vaccination at the time.
Svetlana Valieva: certain measures were taken for it to go away. And when the Spanish flu occurred, it created a certain population of people who had recovered.
Svetlana Valieva: and this is said by a neurosurgeon who performs a unique operation, the only one in Russia. And indeed, your opinion is worth considering.
And I remind you that this was the program “News. Interview.” Our guest was the neurosurgeon Rezida Galimova. We say goodbye to you. Goodbye.
Doctor - Obstetrician-Gynecologist, Ultrasound Diagnostics Doctor