Expressnews
Chennai, 12th January 2023: Royal Care Super Speciality Hospital, Coimbatore reveals India’s First knife-less Brain Surgery MRgFUS – A New Technology for the treatment of Essential Tremors and Tremor Dominant Parkinson’s disease.
Movement disorders have been the most fascinating of all CNS diseases.The discovery of levodopa and dopamine agonists changed the way Parkinson’s disease was treated. The next paradigm shift in the treatment of movement disorder was the introduction of deep brain stimulations. Lesioning surgeries have been in vogue for a long time. A game changer was introduced about 8-10 years back.
MRI guided Focused Ultrasound is this new technology which has the potential to change the way movement disorders are being treated at present. Tremors have for long been treated with various medications without significant benefit. Radio frequency ablation of VIM nucleus of the thalamus has worked wonders with various tremors especially ET, however the technique is fraught with complications and hence not widely practiced.
Speaking about the new technology, Dr. Madeswaran, Chairman, Royal Care Super Speciality Hospital said, “Collimated Ultrasound targeting the VIM nucleus with submillimetre precision is a boon to patients with Essential Tremor (ET). Since the first appearance of a randomised control trial in the NEJM in 2015, scores of patients have been treated all over the world with this technology.”
The advantages are:
1. Submillimetre precision,
2. No major complications,
3. Real time monitoring during procedure,
4. No anaesthesia,
5. No incision/blood loss,
6. Almost 100% effective
7. Totally non-invasive.
Dr.K.Vijayan, Consultant Neurologist & Neuro Sonologist, Royal Care Super Speciality Hospital said, “The tremor vanishes immediately after the procedure and one can get rid of all the drugs. Due to its non-invasive nature the procedure itself is complete in about 2-3 days. At present it has been approved for Essential Tremor and Tremor dominant Parkinson’s disease. Indications are expanding(exploding) with new targets being identified for various problems”.
“The GPi (Globus Pallidus interna) has been identified for rigidity and hypokinesia of PD. The pallido thalamic tract (PPT) is also being worked upon for the same purpose. Various dystonia’s can also be treated by targeting the ventralis oralis (VO) nucleus. The indication is also being expanded for treatment of resistant epilepsy-mesial temporal lobe sclerosis. Targeting tumours and opening the blood brain barrier is also in the pipeline. This treatment modality is now being introduced for the first time in India in Coimbatore. This game changer is well within your reach”, Dr.Vijayan further added.
OUR INITITAL EXPERIENCE – First 3 months herewithwe present the First report of 16 patients with tremors treated with MRg FUS from the Indian Subcontinent.
Stereotactic lesioning of the Ventralis inter medialis of the thalamus has been in vogue for many decades now. Newer targets have been identified for various neurological diseases. Safe and effective lesioning of these targets has finally been achieved with the use of MRgFUS. Herein we report our initial experience in 16 cases using MRgFUS. This is the first case series report from the Indian subcontinent.
16 consecutive cases of tremor -6 Essential Tremor 1 case of dystonic tremor, 2 case of spinocerebellar ataxia type 13, and 6 cases of Tremor Dominant Parkinson’s Disease are reported. All these cases were subjected to VIM Thalamotomy using MRgFUS. The VO nucleus was included in two cases of TDPD and one case of hand dystonia with tremor. In one case of PD lesion was placed in the Forel’s H1 field in addition to VIM.
Tremor decreased in all patients with a significant reduction in CRST score. The 4 initial TDPD cases at the end of 2 monthshad a marked reduction in UPDRS score. All cases of essential tremor were resistant to medications. Patients were administered dexamethasone 4mg twice daily for 3 to 5 days. In 3 of these cases dexamethasone was administered for 1 month. Mild ataxia was reported in all 16 patients. Dysarthria was reported in 10 / 16 patients. One patient had hemiparesis which resolved in one month. Another patient reported subjective weakness in the right upper and lower limb, though there was no weakness on examination. Two patients reported burning pain in the back during procedure and target was moved 1mm anteriorly. One patient with TDPD reported improvement in voice.
MRgFUS is a novel and safe therapeutic tool for the treatment of movement disorders.
