Rivkah Bornshtein, an 82-year-old wife, mother, grandmother of 4, and resident of Haifa, is the first woman in Israel to undergo a second, innovative, non-invasive medical procedure to treat tremors caused by Parkinson’s disease – 7 years after the initial procedure.
Rivkah Bornshtein with the Rambam HCC medical team that participated in the procedure. L-R) Dr. Ayelet Eran, Dr. Marius Constantinescu, Dr. Alon Sinai, Dr. Ilana Schlesinger, and Dr. Olga Sandler. Photography: Rambam HCC
Seven years ago, Rivkah Bornshtein was among the first patients at Rambam Health Care Campus, and in Israel, to benefit from a revolutionary treatment, magnetic resonance imaging (MRI)-guided focused ultrasound (FUS) for Parkinsonian tremor. However, at the time, the treatment could only be applied to one hand. As time passed, the tremors in her other hand worsened. Bornshtein returned to her doctors at Rambam.
First performed in Israel at Rambam, MRI-guided FUS is used to treat Essential or Parkinsonian tremors. The procedure uses high-intensity ultrasound waves to precisely target the diseased area of the brain without affecting any of the surrounding tissue. The ultrasound rays pass through the intact skull and pinpoint a particular area in the center of the brain (the thalamus) for ablation. The result is interruption of the abnormal flow of electrical signals with and cessation of tremor. Surgeons use MRI to accurately direct the ultrasound waves to the specific site in the brain where the tremor is initiated – hence the treatment name – MRI-guided FUS. The procedure is performed with a local anesthetic, with minimal discomfort to the patient.
Although MRI-guided FUS has been proven to be successful, there were some concerns regarding a second procedure for Bornshtein. Dr. Alon Sinai, a neurophysiologist in Rambam’s Movement Disorders Institute explained, “There have been attempts to perform the same procedure in other parts of the body by hospitals abroad, but the fear of irreversible side-effects was always present. However, we believed that using FUS, the side-effects could be completely preventable – and we were right.”
Dr. Ilana Schlesinger, the Director of the Movement Disorders Institute in the Department of Neurology at Rambam, added, “The procedure uses ultrasound and is designed to prevent tremors caused by Parkinson’s disease. Tiny areas of the brain are heated and the tremors cease. Bornshtein suffered from severe tremors in both of her hands. We treated one hand initially and the tremors stopped. This time, after performing the procedure a second time, the tremors in her other hand, ceased as well.”
Bornshtein is delighted with the results and only one-and-a-half-hours after the procedure, her tremors had ceased altogether. “I feel very well. The decision to move forward with the second procedure was a difficult one to make, especially when I understood that I would be the first patient to do so. I had many sleepless nights but my husband encouraged me. He was confident that as the procedure had been successful the first-time round, there would be no reason to doubt its success a second-time round. Once I had made up my mind, I had no fears or concerns and as soon as the procedure was over, I realized it had been successful. The medical team at Rambam Health Care Campus were wonderful and they did an amazing job. The quality of my life has improved tremendously.”
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