Essential tremor (ET) is one of the most common
movement disorders, yet only about 50 percent of patients
receive satisfactory benefit from the currently available
medications. For patients with disabling tremor that is
not adequately controlled by propranolol, primidone, or
other medications, surgical treatments may be an option.
Advances in the understanding of brain anatomy, more
detailed imaging methods to better see the brain, and
improved surgical techniques now allow for greater surgical
accuracy and increased benefits with fewer complications
than when surgical treatments were first introduced. Current surgical options for ET include deep brain stimulation (DBS) and thalamotomy.
Potential candidates for surgical procedures are ET
patients who do not experience satisfactory tremor control
with medications, and who have disabling tremor that
affects their ability to perform activities of daily living such
as eating, writing, drinking, dressing, working, or enjoying
their hobbies.
Surgical Option in Essential Tremor:
Deep Brain Stimulation
Deep brain stimulation (DBS) surgery is an FDA-approved treatment that has been proven to significantly reduce the tremor associated with ET. In DBS surgery, there is no destruction of the brain. Rather, a wire (electrode or lead) is placed in the ventral intermediate nucleus (VIM) nucleus of the thalamus, located deep in the brain. The wire connects under the skin to a pacemaker-like device in the chest that provides mild electrical currents to control symptoms. In ET, DBS of the VIM nucleus of the thalamus is the most commonly used surgical procedure to control tremor.
Patients who have significant memory problems and patients who have unstable medical conditions that would increase surgical risk are not candidates for surgery. Persons with other medical conditions requiring repeated MRI using a full body scan also may not be candidates for DBS.
Stereotactic Thalamotomy
Stereotactic thalamotomy is a surgical procedure that destroys part of the thalamus in order to block the abnormal brain activity
thought to cause ET. Currently, thalamotomy is rarely performed due to the risk of serious side effects and the availability of DBS, which is safer, does not destroy brain tissue and has fewer complications.
Gamma Knife® Radiosurgical Thalamotomy
Gamma Knife® radiosurgical thalamotomy is a technique in which a thalamotomy is performed with beams of radiation rather than a surgical incision or use of electrodes. In a single outpatient treatment, the surgeon uses a Gamma Knife device to focus high-energy gamma rays precisely on an area in the brain that causes tremor. These rays result in the death of the brain cells that generate ET. The procedure takes approximately one hour and the benefit may not be apparent until three to six weeks afterward. This procedure should be restricted to patients with severe tremor who because of unstable medical conditions are not candidates for DBS.
movement disorders, yet only about 50 percent of patientsreceive satisfactory benefit from the currently available
medications. For patients with disabling tremor that is
not adequately controlled by propranolol, primidone, or
other medications, surgical treatments may be an option.
Advances in the understanding of brain anatomy, more
detailed imaging methods to better see the brain, and
improved surgical techniques now allow for greater surgical
accuracy and increased benefits with fewer complications
than when surgical treatments were first introduced. Current surgical options for ET include deep brain stimulation (DBS) and thalamotomy.
Potential candidates for surgical procedures are ET
patients who do not experience satisfactory tremor control
with medications, and who have disabling tremor that
affects their ability to perform activities of daily living such
as eating, writing, drinking, dressing, working, or enjoying
their hobbies.
Surgical Option in Essential Tremor:
Deep Brain Stimulation
Deep brain stimulation (DBS) surgery is an FDA-approved treatment that has been proven to significantly reduce the tremor associated with ET. In DBS surgery, there is no destruction of the brain. Rather, a wire (electrode or lead) is placed in the ventral intermediate nucleus (VIM) nucleus of the thalamus, located deep in the brain. The wire connects under the skin to a pacemaker-like device in the chest that provides mild electrical currents to control symptoms. In ET, DBS of the VIM nucleus of the thalamus is the most commonly used surgical procedure to control tremor.
Patients who have significant memory problems and patients who have unstable medical conditions that would increase surgical risk are not candidates for surgery. Persons with other medical conditions requiring repeated MRI using a full body scan also may not be candidates for DBS.
Stereotactic Thalamotomy
Stereotactic thalamotomy is a surgical procedure that destroys part of the thalamus in order to block the abnormal brain activity
thought to cause ET. Currently, thalamotomy is rarely performed due to the risk of serious side effects and the availability of DBS, which is safer, does not destroy brain tissue and has fewer complications.
Gamma Knife® Radiosurgical Thalamotomy
Gamma Knife® radiosurgical thalamotomy is a technique in which a thalamotomy is performed with beams of radiation rather than a surgical incision or use of electrodes. In a single outpatient treatment, the surgeon uses a Gamma Knife device to focus high-energy gamma rays precisely on an area in the brain that causes tremor. These rays result in the death of the brain cells that generate ET. The procedure takes approximately one hour and the benefit may not be apparent until three to six weeks afterward. This procedure should be restricted to patients with severe tremor who because of unstable medical conditions are not candidates for DBS.
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