Practical tips for MRGFUS treatment (Online Book)

Yulia Allabirdina prepares a magic MRGFUS device

A magic of MRgFUS vs DBS, gamma knife, and radiofrequency ablation.

Until the last decade, Doctors used to treat essential tremor by administering various medications, performing deep brain stimulation (DBS) surgery, gamma knife treatment, and radiofrequency thalamotomy. These treatments have been used as standard treatments for essential tremor.

1. Conservative treatment of the Essential Tremor with medications.

Tremor often cannot be adequately controlled with medication. Drug therapy is associated with side effects such as dizziness and, quite often, may not help.

2. Deep brain stimulation (DBS) treatment of the Essential Tremor

Deep brain stimulation is a neurosurgical procedure in which electrodes are implanted in the nuclei or pathways of deep brain structures and stimulated with an alternating electrical current. This operation achieves a significant reduction in jitter. The advantage of this technique is that it can treat both sides of the body at once, but like any invasive surgery, deep brain stimulation comes with risks such as infections or cerebral hemorrhage, and the pacemaker needs to be changed every few years.

3. Gamma knife thalamotomy for the treatment of tremor

A thalamotomy with a gamma knife allows you to aim beams of ionizing radiation at an area suspected of tremor and irradiate it. The method’s main disadvantage is that anatomical landmarks determine the target area. Deviation of the position of target nuclei from typical anatomy occurs in up to 40% of cases. The exposure effect becomes unpredictable if the radiation is aimed at an innocent site. Complications may increase over several months due to the gradual death of brain cells in the irradiated area. The literature even describes cases of death after such treatment.

4. Radiofrequency (RF) thalamotomy for the treatment of Essential Tremor

Radiofrequency ablation is a neurosurgical operation in which under anesthesia. The surgeon inserts electrodes into the brain. Then the patient is awakened. The patient performs tests to let the surgeon find the area responsible for the tremor. Then this target is cauterized with radiofrequency exposure, such as in a microwave oven. The disadvantage of the operation is, first of all, damage to the brain during the conduction of electrodes.

5. MRI guided focused ultrasound treatment (MRGFUS) of tremor

MRI-guided focused ultrasound can effectively and gently treat patients with essential tremor. A new treatment for essential tremor and tremor-predominant parkinsonism developed by Insightec and CE marked, i.e., approved in Europe, approved by the FDA in the USA.

To date, it has successfully treated about 5,000 patients worldwide.

First, the safety and efficacy of tremor treatment with MRI-guided focused ultrasound is related to the fact that there is no need to open the skull and penetrate the brain with instruments.

Secondly, one of the incredible advantages of this method is that it allows you to probe areas of the brain that are suspicious in hand trembling (tremor) with an accuracy of 0.1 mm using ultrasound. Ultrasound has a wonderful property. It can “stun” brain cells for 2-3 minutes. So the doctor can simulate and check what will happen if you turn off this part of the brain in a given person. The doctor can determine whether the impact on this particular area will help in the fight against hand tremors. This approach avoids disrupting brain functions, such as numbness, and speech disorders, in treating tremor.

ConservativeDBSRFAGamma knifeMRgFUS
Trephination and trepanationNOYESYESNONO
Radiation exposure and damagesNONONOYESNO
Instrument Insertion NOYESYESNONO
Implant foreighn bodies in the brainNOYESNONONO
Reoperation due to the battery dishaustNOYESNONONO
Is check of the target before ablation possible?NOYES, after insertion of the electrodeYES, after insertion of the electrodeNOYES, with no insertions
Bleeding riskNOYESYESExtremely low Extremely low
Infection riskNOYESYESNOSkin only
NarcosisNOWake-up during target checkWake-up during target checkNONO
Average hospitalization time 7 days7 daysless than dayless than day
ICUProbableProbableExtremely lowExtremely low
Double sided treatmentStaged or immediateAvoid because of disartria riskNOStaged or immediate
Comparison table of MRGFUS treatment of essential tremor with other options: deep brain stimulation (DBS), gamma-knife, and radiofrequency ablation.
Read more: Is it possible to perform MRGFUS with remote supervision?

Igor Buzaev

The co-founder of the first in Russia MRGFUS neurosurgery centre. Doctor of Science in Medicine. Professor of surgery department of Bashkir State Medical University.

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