First use of MRI-guided focused ultrasound to treat patients with essential tremor in Russia

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Abstract

Introduction. Treatment with MRI-guided focused ultrasound (MRgFUS) is a new, non-invasive surgical technique for treating extrapyramidal movement disorders. This article presents the first use of MRgFUS in Russia for treating patients with essential tremor (ET).

Materials and methods. Patients (n = 26; 17 men and 9 women) aged 21–82 years (median age 46.0 years) and with severe and refractory ET, underwent MRgFUS thalamotomy (ExAblate 4000, Insightec). One side was treated in 22 patients (left thalamus in 18 and right thalamus in 6), both sides were treated concurrently in two patients, and both sides were treated consecutively in two patients. Tremor was assessed using the Clinical Rating Scale for Tremor (CRST). Because international clinical specialists could not visit Russia due to the COVID-19 pandemic, MRgFUS was performed via telehealth on May 5, 2020, in a world first.

Results. A satisfactory result was achieved in 25 (96%) out of 26 patients. CRST scores improved by 64.7% on the side of the operation, by 10.2% on the control side, and by 37.5% overall. Intraoperative side effects included headache during sonication (42.3%), vertigo (15.4%), nausea (11.5%), vomiting (7.7%), numbness (3.8%), ataxia (3.8%), and pathological response to cold exposure (3.8%). The symptoms resolved immediately after surgery. Unstable gait was noted in five patients, which completely resolved two weeks after surgery. Median postoperative follow-up duration was 109 days [53; 231], with a maximum of 625 days. No relapses (if the hyperkinesia had completely disappeared) or increased tremor (if reduced after surgery) were observed.

Conclusion. The efficacy of MRgFUS for ET was 96%, with no long-term complications. Both bilateral concurrent and bilateral consecutive MRgFUS thalamotomy is possible, but its efficacy and safety should be assessed in a randomized study. In a world first, MRgFUS was successfully implemented using telehealth.

About the authors

Rezida M. Galimova

Bashkir State Medical University; Intelligent Neurosurgery Clinic, International Medical Center V.S. Buzaev Memorial

Email: rezida@galimova.com
ORCID iD: 0000-0003-2758-0351

Cand. Sci. (Med.), Department of neurosurgery, Chief, neurosurgeon

Russian Federation, Ufa; 450059, Ufa, Richard Zorge str., 17/4

Dinara I. Nabiullina

Intelligent Neurosurgery Clinic, International Medical Center V.S. Buzaev Memorial

Email: nabiullina.dinara@yandex.ru
ORCID iD: 0000-0003-2570-3709

neurologist

Russian Federation, 450059, Ufa, Richard Zorge str., 17/4

Sergey N. Illarioshkin

Research Center of Neurology

Email: snillario@gmail.com
ORCID iD: 0000-0002-2704-6282

D.Sci. (Med.), Prof., Academician of the RAS, Deputy Director

Russian Federation, Moscow

Shamil M. Safin

Bashkir State Medical University

Email: safinsh@mail.ru
ORCID iD: 0000-0002-0100-6100

D. Sci. (Med.), Prof., Head, Department of neurosurgery

Russian Federation, Ufa

Yulia A. Sidorova

Intelligent Neurosurgery Clinic, International Medical Center V.S. Buzaev Memorial

Email: yuliasi.ufa@gmail.com
ORCID iD: 0000-0002-0992-0239

neurologist

Russian Federation, 450059, Ufa, Richard Zorge str., 17/4

Gulnara N. Akhmadeeva

Bashkir State Medical University; Intelligent Neurosurgery Clinic, International Medical Center V.S. Buzaev Memorial

Email: nevrolog.ufa@gmail.com
ORCID iD: 0000-0001-5516-0587

Cand. Sci (Med.), Department of neurology, neurologist

Russian Federation, Ufa; 450059, Ufa, Richard Zorge str., 17/4

Nailya R. Mukhamadeeva

Bashkir State Medical University; Intelligent Neurosurgery Clinic, International Medical Center V.S. Buzaev Memorial

Email: ishtu2013@yandex.ru
ORCID iD: 0000-0001-5158-2707

cardiologist

Russian Federation, Ufa; 450059, Ufa, Richard Zorge str., 17/4

Naufal Sh. Zagidullin

Bashkir State Medical University

Email: znaufal@mail.ru
ORCID iD: 0000-0003-2386-6707

D. Sci. (Med.), Prof., Head, Department of internal diseases

Russian Federation, Ufa

Olga V. Kachemaeva

Bashkir State Medical University; Intelligent Neurosurgery Clinic, International Medical Center V.S. Buzaev Memorial

Email: olga.kachemaeva@gmail.com
ORCID iD: 0000-0001-9949-9582

Cand. Sci. (Med.), Associate Professor, Department of neurology, neurologist

Russian Federation, Ufa; 450059, Ufa, Richard Zorge str., 17/4

Dmitriy K. Krekotin

Intelligent Neurosurgery Clinic, International Medical Center V.S. Buzaev Memorial

Email: krekotin@yandex.ru
ORCID iD: 0000-0002-2215-7178

Assistant, Department of MRI

Russian Federation, 450059, Ufa, Richard Zorge str., 17/4

Igor V. Buzaev

Bashkir State Medical University; Intelligent Neurosurgery Clinic, International Medical Center V.S. Buzaev Memorial

Author for correspondence.
Email: igor@buzaev.com
ORCID iD: 0000-0003-0511-9345

D. Sci. (Med.), Prof., Surgery department, cardiovascular surgeon

Russian Federation, Ufa; 450059, Ufa, Richard Zorge str., 17/4

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Supplementary files

Supplementary Files
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2. Fig. 1. Density plot for patient gender and age.

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3. Fig. 2. Scatter plot for correlation between experience and operation effect.

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4. Fig. 3. Distribution diagram of skull bone density.

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5. Fig. 4. Ultrasound technician prepares the DQA Phantom.

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6. Fig. 5. Surgical team secures the patient's head.

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7. Fig. 6. Correlation between surgery duration and bone density.

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8. Fig. 7. CRST scores before and after surgery (for each side).

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9. Fig. 8. CRST total (for both sides) scores before and after surgery.

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Copyright (c) 2022 Galimova R.M., Nabiullina D.I., Illarioshkin S.N., Safin S.M., Sidorova Y.A., Akhmadeeva G.N., Mukhamadeeva N.R., Zagidullin N.S., Kachemaeva O.V., Krekotin D.K., Buzaev I.V.

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