In the latest episode of the program “Doctor I.” from May 18, 2022, the first Russian MRgFUS neurosurgeon Rezida Maratovna Galimova talks about how essential tremor was treated with MRI-guided focused ultrasound at the V.S. Buzaev International Medical Centre. A patient also shares her impressions during and after the treatment of tremor with focused ultrasound.
Hosts: Dr. Irina Pershina and Kirill Radzig
Kirill Radzig: About a month ago in this studio on our program, viewer Olga Dokuchaeva shared how difficult it is to live with a condition like essential tremor.
Irina Pershina: In the same program, we talked about a new treatment method that helps to get rid of this disease. Olga agreed to undergo the procedure, and today she came to our studio. Also, with her came the doctor who performed the treatment, neurosurgeon, PhD Rezida Galimova. Good morning.
Rezida Galimova: Hello. Good morning.
Irina Pershina: Olga, I remember in our last conversation you expressed some doubts and concerns about starting treatment. But you decided to go ahead. Was it easy to take this step?
Olga Dokuchaeva: Scary, difficult, but necessary. In short, I decided, and I absolutely do not regret it. When I arrived in Ufa and spoke with the doctor, I felt such trust that I decided.
Irina Pershina: Rezida Maratovna, how do you manage to set patients on a positive note so that they willingly and gladly start treatment?
Rezida Galimova: We always explain to patients in detail how the treatment proceeds. The patient is conscious. This already instills great trust and confidence. We tell them that they will always have the opportunity to communicate with us. During the treatment, the patient has a special button that they can press to stop the treatment if something is uncomfortable, if they notice any side effects, or if they suddenly feel pain or fear. We then come and address the situation.
Irina Pershina: Well, it’s also a certain aspect that adds confidence.
Rezida Galimova: Of course. And relatives are always with the patients. We always ask that spouses, relatives, and children accompany the patient. Our approach is quite different. We strive to work as a team. That is, the family, the patient. When we become a unified team, that’s 70% of success.
Essential tremor is a disease that progresses with age. That is why it is important, as soon as a person has the opportunity, to eliminate this condition to avoid further complications and not worsen the quality of life.
In fact, essential tremor progresses with a gradual development of the clinical picture. Initially, the patient most often experiences trembling in one hand, then gradually trembling in the other hand joins, and subsequently, for example, trembling of the head may occur. The trembling becomes unbearable and limits the patient in social, domestic, and professional life. Over the years, people may even stop taking care of themselves and require assistance. Therefore, it’s impossible to say when the ideal time for surgery is. The time for surgery is when the patient says, “I can no longer work or live like this, I constantly need help, I need to be socially active and independent.” When the patient asks themselves this question and the answer is yes, yes, yes, then it is the right time for surgery.
Irina Pershina: Before we look at the results of this procedure, let’s remind our viewers what this procedure entails.
Rezida Galimova: During the operation, we use physics, specifically ultrasound waves, which have the ability to penetrate the brain and remove the area causing tremor. This ability is utilized in two stages.
In the first stage, we direct beams in a specific small quantity and heat the brain to 45 degrees. During this time, temporary paralysis of nerve cells occurs, and they stop functioning. We observe the patient’s hand tremor stopping. We enter the operating room and check the patient to ensure that we have not caused any negative effects, disruptions, or deterioration of the patient’s condition, and that we have not affected any important areas of the brain. Only after this do we proceed with the final treatment. These effects are called sonications
Irina Pershina: Olga, could you please tell us what the preparation stage for this medical procedure involved?
Olga Dokuchaeva: Started by shaving off all the hair completely. At first, I thought, as a woman, maybe just parts of it? No, they shaved the entire head. After that, they put on a helmet, which was secured tightly on the head. Then they put on a special helmet through which the signal the doctor mentioned was transmitted.
Irina Pershina: Rezida Maratovna, could you please tell us how the procedure went for Olga? Were there any unforeseen moments? Or did everything go according to protocol, smoothly, to the desired result?
Rezida Galimova: In principle, overall, the operation went as standard. It lasted about two hours. Olga Borisovna turned out to be a very patient individual. She had a slightly low pain threshold because during the ultrasound procedure, Olga noted slight pain. We conducted all stages of the operation together: Olga Borisovna’s husband was present during the operation. You can now see how we are forming the spot. The dark blue on the screen is exactly the thermal spot that the equipment shows us. During the operation, MRI is constantly performed, and we can see which area and volume of the brain we managed to remove at this point. And now you see that…
As we enlarge this area and remove the nerve cells involved in the formation of tremor, Olga Borisovna feels better and better with each stage of the operation. That is, until we are satisfied with the result and the patient is satisfied with the result, this is the point where we can stop. And we have no side effects. During the operation, the neurologist constantly monitors and observes. Neurologist Yulia Alexandrovna was present here, observing Olga Borisovna. After each ultrasound exposure, we check the patient from head to toe to confirm that we have not affected anything and are in a safe zone.
Kirill Radzig: So, it was a preliminary reconnaissance to see if we were in the right place. Olga, it’s really interesting to know what you felt when, almost in real-time, you could say, your physical state was changing. What did you feel at that moment when you could already draw those straight lines?
Olga Dokuchaeva: I didn’t believe it. I didn’t believe what was happening.
Irina Pershina: And now, perhaps the most important and interesting part. Let’s watch those first minutes captured by our operators. Right after the end of the operation. Let’s take a look.
Rezida Galimova (with a patient in the room): We have such an exercise. Let’s do it. You put your finger – and I’ll put mine! Is it working?
Olga Dokuchaeva (in the ward): It definitely won’t break anymore. But she listens to everything!
Irina Pershina: It’s probably impossible to describe all the feelings you experienced. Because even we, people who are not present at the surgery itself, can’t just watch this video!
Olga Dokuchaeva (wiping away tears): I’m sorry, I looked too.
Irina Pershina: Indeed, it seems that progress has come a long way. Medicine is advancing. But such a miracle… My grandfather suffered from a similar condition. I remember how he struggled all his life. Back then, of course, such treatment methods didn’t exist. I’m just happy that it has become available to people.
Kirill Radzig: It’s just a real miracle, guys!
Rezida Galimova: And can you imagine how we work with the team when patients come to us, but there are patients who start crying on the table. That is, they go through the first line and cry. And when I look at the members of our team, I see that everyone, we all wear masks, everyone’s eyes are wet. It was the same when we entered Olga Borisovna’s room, and everyone just blinked frequently to hold back tears because it’s very emotional.
Irina Pershina: Olga, show how you can do that. It’s just some kind of miracle
Kirill Radzig: Was it two such hands? We clearly remember how it was here a month ago. And when will there be two such hands? Please tell me, can it be done in one stage, one against the other first?
Rezida Galimova: It is impossible to immediately eliminate tremor in both limbs.
After the surgery, we experience swelling of the nerve cells located near the area where we are working. Patients observe certain changes. Gait, unsteadiness. If there are two lesions and two points, it will be twice as difficult for patients to endure the postoperative period. This is the first point. And the second point. In the last century, in the 50s and 60s, radiofrequency ablation surgeries were actively performed.
And in Japan, when performing operations on both sides simultaneously, it was noticed that most patients experienced speech disorders in the form of dysarthria. Therefore, since those ancient times, neurosurgeons have developed a fear that if we operate on both sides, we will get the same result. But there are certain tricks that we adhere to. And Olga Borisovna will have a second operation, but in 9-12 months with a different approach. That is, the targets are formed slightly apart from each other, they are positioned to avoid complications such as speech disorders.
Irina Pershina: What does this time depend on? You said in a year, in 9 months. Do you somehow monitor the patient’s condition, or do circumstances just somehow develop in a certain way?
Rezida Galimova: We are monitoring the focus, we will perform MRI at 3, 6, 9, and 12 months, and we are observing that the swelling…
Irina Pershina: So, several MRIs will need to be done this year as part of your monitoring.
Rezida Galimova: We observe that in the area where we performed the operation, the swelling has subsided, the patient feels well, everything is stable, there are no complications, and after this, we prepare for the second operation.
Kirill Radzig: Olga, you look magnificent, cheerful, beautiful. Tell us, how has your life changed after this surgery?
Olga Dokuchaeva: I have such brightness in my life now, I can eat with my right hand, I can drink with my right hand, I can do everything, I don’t quite understand it. I am enjoying this state.
Irina Pershina: Olya!
Thank you very much for sharing your story with us and for being in our studio, Rezida Maratovna. A special bow to you for your work, for restoring health to your patients, and for changing lives for the better. Thank you so much.
Doctor - Obstetrician-Gynecologist, Ultrasound Diagnostics Doctor