Your MRGFUS team should always perform a neurological examination of the patient between sonications. Different centers treat the scope of the patient examination in different ways. Some centers don’t do a complete neurological exam between sonications. In Buzaevclinic we do full exam every time.
For example, they may check to see if the tremor or abnormal set in dystonia has been cured and then move on to the next sonication, they only evaluate whether there is an effect from sonication. This approach may be practical in terms of cost-effectiveness and the image of a “fast” surgeon. But examination is needed far from only to evaluate the effectiveness of tremor treatment.
A complete exam takes no more than 15 minutes, but this can provide information about the complications that threaten. It allows you to evaluate the balance of effectiveness and safety of the treatment and stop in time.
Why is a complete neurological examination required during MRI-guided focused ultrasound treatment for tremors?
1. To treat the patient effectively
On examination, eliminating tremors or other motor impairments after sonication indicates a correctly selected target. This observation is good news. You could treat and complete the treatment. But what if a more substantial impact causes a complication?
2. To cure your patient safely
A complete neurologic examination reveals unexpected neurologic deficits due to atypical anatomy. Imagine if you did not assess the condition of the lower limb, and there a neurological deficit was brewing. Exposure to ultrasound in treatment mode will aggravate and permanently aggravate the problem. In our experience, we have met neurological deficits that should not have been. We could have missed them if we had cut corners.
3. To do your job honestly
The completeness of the inspection is another important legal, moral, and ethical point. If you get a complication, how will you answer the question, “Have I done everything to avoid this?”.
4. It is skyrocket for your image
It is helpful from a marketing standpoint. We allow relatives to see and participate in the procedure. The patient and relatives see how attentive the team is to details. This open approach dramatically increases your trust and loyalty in the future. It’s great to hear delight from the patient with the words, “I’ve been sick for 20 years, but no one has ever looked at me like that!”.
5. It gives a time to think
A complete neurological examination allows you to discuss with the patient and relatives the further course of the operation. Because it takes time, it’s your time. It happens that it is enough to draw the attention of the patient and relatives to your neurological findings to coordinate with them the completion of the procedure with a suboptimal result to avoid complications.
6. It grows your team
A complete neurological examination develops the whole team and allows you to train new young professionals for work in the operating room and routine patient examinations.
7. It gives you recovery and some rest
And yet, this is a time to think, reflect, take a timeout, meditate and make a more informed decision in difficult situations. And if your neurologist is attentive and careful enough, you will have time to take a sip of refreshing and uplifting coffee on the run.
Next, we offer our mandatory neurological examination protocol for focused ultrasound treatment.