Conclusion
The experience gained in recent years with MRgFUS for extrapyramidal and other nervous system disorders shows that this technology represents more than just a new method of functional therapeutic impact on the brain based on a stereotactic approach. Essentially, thanks to MRgFUS, we are now talking about erasing the boundary between conservative and surgical neurology. This significantly expands the possibilities of providing effective assistance to various categories of patients with severe, often disabling movement, sensory, and behavioral disorders.
As discussed in the monograph, MRgFUS represents, on one hand, a certain alternative DBS (taking into account the existing limitations for macroelectrode brain stimulation due to its invasive nature, surgical risks, the need for constant monitoring of the stimulator’s operation mode, etc.), and on the other hand, a qualitatively new level of ablative stereotactic neurosurgery. For example, trial reversible ultrasound interventions allow modeling the effect on a specific area of the brain and finding the most effective target for a particular patient VIM, PTT, VO, ZI and others – in isolation or in combinations). Positive experience has been gained worldwide and in our clinic with effective two-stage treatment, i.e., safe repeat surgeries when symptoms return in patients with ET, PD, dystonias. The application of several developed methodological techniques (asymmetry of created lesions, timely cessation of impact on the second side with sufficient antitremor effect, symptom control during trial sonications) has breathed new life into the idea of bilateral stereotactic ablations in ET and potentially in other movement disorders. Our results indicate that such operations using MRgFUS can be safe both in staged and simultaneous execution, but this requires strict adherence to all requirements and adequate consideration of existing risks, indications, and contraindications.
It can be expected that the use of MRgFUS for the treatment of various movement disorders will gradually expand. Simultaneously, methodological foundations and indications for the use of ablative high-intensity MRgFUS modes will be refined for non-movement neurological disorders—pain syndromes, epilepsy, affective disorders resistant to conservative therapy, hydrocephalus, thrombotic ischemic stroke for the purpose of artery recanalization, etc. The initial results of such interventions look promising, although significant additional experimental and multicenter randomized clinical studies are still required here.
A promising variety of MRgFUS is the use of low-intensity ultrasound exposure. It allows for temporary opening of the BBB for the treatment of neurodegenerative and other CNS diseases and also lays the foundation for implementing a fundamentally new mode of neuromodulation in practice. This demonstrates the significance of MRgFUS not only for clinical practice but also for fundamental neurology and neurophysiology.
Thus, despite its youth, the MRgFUS method has already firmly established itself and confidently looks to the future.