Complications resulting from a common Parkinson’s treatment left Tatiana Sablina in a wheelchair. Thanks to another breakthrough with focused ultrasound (FUS), she is walking again.
Tatiana Sablina prepares to leave Rambam. Credit: Rambam HCC.
Tatiana Sablina, 66, a resident of Acre in Northern Israel, is heading home after being discharged from Rambam. She stands in front of a mirror in the inpatient department, arranges her headscarf, walks to the bed, collects her belongings, exits the room, and says farewell to the medical team. “It’s unbelievable,” says one of the nurses, “It’s a miracle. Just a few days ago, she needed a wheelchair and help with almost everything. Look at her now. It’s like nothing was ever wrong.”
Behind this miraculous moment is a relatively short, non-invasive medical procedure that lets patients with movement disorders (like essential and Parkinsonian tremor) regain their quality of life. Within a few hours, Sablina, a new immigrant from Russia, with advanced Parkinson’s disease, recently became the first in Israel to undergo a focused ultrasound (FUS) procedure at five different sites in her brain.
While still living in Russia, Sablina had been treated with deep brain stimulation (DBS), a well-known treatment for Parkinson’s: a pacemaker-like device (stimulator) is implanted near the patient’s collar bone and sends pulses to electrodes placed at targeted locations within the brain. Unfortunately, complications developed and 9 months ago, Sablina began receiving treatment at Rambam Health Care Campus (Rambam) in Haifa, Israel, for a severe infection near the implant.
Rambam physicians tried to save the DBS by treating Sablina with antibiotics and other needed drug therapies. Dr. Lior Lev Tov, attending physician in the Department of Neurosurgery at Rambam explains, “We were unsure. On the one hand, her infection was life-threatening, but on the other hand, her ability to function was dependent on the stimulator. Replacing the device with a new one would involve another surgical procedure, which could again cause a chronic, life-threatening infection. In the absence of a positive response to the drug treatment she was receiving, our options were limited.”
With her well-being clearly at risk, Sablina’s medical team opted for a revolutionary solution: removing the brain stimulator for a few months to allow the infected area to heal. However, she has been extremely dependent upon the device. Multiple attempts to stabilize her condition with drug therapy failed, and Sablina became bedridden and was forced to move into an assisted living facility.
After the infection had healed, Sablina returned to Rambam, this time to undergo a revolutionary form of MRI-guided FUS. The procedure, performed in only a few centers worldwide, would use MRI to guide ultrasound waves to treat specific areas of her brain. In this groundbreaking procedure, conducted at a limited number of centers worldwide, and for the first time in Israel, Dr. Lev Tov performed FUS in five different areas of Sablina’s brain to simultaneously address her Parkinsonian stiffness, slowness, and tremors. After the procedure, her condition significantly improved and she can now walk and perform various actions without assistance.
“At Rambam, we dared to do something never been done before,” says Dr. Ilana Schlesinger, director of the Movement Disorders Institute, and senior physician in the Department of Neurology. “Today, patients with advanced Parkinson’s disease undergo invasive brain surgeries, but these procedures can have serious complications, as we have seen in this case. Now, we can offer a treatment that reduces tremors and noninvasively addresses all the symptoms of Parkinson’s disease: no drilling into the skull, no risk of bleeding, and no chance of infection. Instead of hours of surgery, FUS only takes one to two hours. We are witnessing a revolution in the treatment of Parkinson’s. It is great news for patients in Israel and around the world.”
Dr. Lev Tov completed a fellowship in neurosurgery at Standford’s Department of Neurosurgery in the USA. “Today’s technology allows us to think about out-of-the-box solutions for patients with poor quality of life,” he says. “Sablina is the first patient in the world to undergo FUS after having been treated with DBS. Seeing her transition from great functional difficulty to almost normal is an exciting turning point. It’s a moment when you realize the power we have to change people’s lives.”
Despite her initial skepticism, Sablina can hardly believe the outcome. “I am so happy,” she says a few days after the procedure, “There is no comparison between the before and after, and this is just the beginning,” she promises with a smile.
Brain Surgery Without a Knife: The Sky is the Limit
An Israeli start-up company called “Insightec” developed the treatment of primary tremors or Parkinsonian tremors using FUS. It was first used at Rambam when it was incorporated into Israel’s national basket of healthcare services in 2013.
This non-invasive, MRI-guided procedure uses advanced technology - a helmet with over one thousand ultrasound transmitters that safely burn specific areas of the brain without having to drill, open the skull, or use a surgeon’s knife. Immediately following the treatment, which usually takes a few hours, a significant improvement is noted; after a few hours, the targeted tremors usually disappear. With high success rates, Rambam is a worldwide leader for treating movement disorders. Rambam was recently chosen to lead the way with the next generation of FUS devices (Insightec’s EXABLATE PRIME), providing a significant improvement in the safety and quality of treatment.
The success of Sablina’s treatment represents a leap forward with FUS therapy, enabling exploration of treatment options for previously unaddressed diseases and conditions. Rambam and Insightec have been collaborating for over a decade in developing this new technology. Rambam serves as a leading research and treatment hub in the field of FUS worldwide.
(L-R) Dr. Ilana Schlesinger, Dr. Alon Sinai, neurophysiologist, Movement Disorders Institute,
and Dr. Lior Lev Tov.
Photography: Rambam HCC
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