Tremor surgery

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Zehra Malik, M.B.B.S [2]

Overview

Surgery is not the first option in treating any cause of tremor. It is applied once non-pharmacological and pharmacological therapy fails. Botulinum neurotoxin injections, thalamotomy, deep brain stimulation, magnetic resonance-guided focused ultrasound, and radio-surgical gamma knife thalamotomy are the most common interventional procedures to treat tremors.

Botulinum neurotoxin injections:
- It has shown improvement in patients with hand tremor, regardless of the etiology. ^[1]
Thalamotomy: ^[2]
- Helpful in medication-resistant essential tremor, cerebellar tremor, or Parkinson's disease related tremor.
- Tremor is permanently treated by creating lesions in the thalamus responsible for causing tremors.
- Most common side effects are dysarthria, cognitive impairment, and imbalance.
- It is an invasive procedure.
Deep brain stimulation: ^[3]
- Parkinson's disease and essential tremor may benefit from deep brain stimulation.
- In this non-invasive procedure, electrodes are implanted to send high-frequency electrical signals to the thalamus, substantia nigra, or globus pallidus. The downside of deep brain stimulation is the expense, and long-term benefits are not established. It is reversible.
Magnetic resonance-guided focused ultrasound (MRgFUS): ^[4]
- Noninvasive thalamotomy procedure uses thermal ablation.
- Used in severe medication-resistant essential tremor or Parkinsonian tremor.
- Most of the side effects reported did not last more than three months.
Radio-surgical gamma knife thalamotomy: ^[5]
- It is found to be safe if done unilaterally.
- Optimum dose from 130 to 150Gy is well tolerated.
- Most common side effects are mild contralateral numbness and transient hemiparesis.

↑ Niemann N, Jankovic J (2018). "Botulinum Toxin for the Treatment of Hand Tremor". Toxins (Basel). 10 (7). doi:10.3390/toxins10070299. PMC 6070882. PMID 30029483.
↑ Bahgat D, Magill ST, Berk C, McCartney S, Burchiel KJ (2013). "Thalamotomy as a treatment option for tremor after ineffective deep brain stimulation". Stereotact Funct Neurosurg. 91 (1): 18–23. doi:10.1159/000342491. PMID 23154796.
↑ Lyons KE, Pahwa R (2008). "Deep brain stimulation and tremor". Neurotherapeutics. 5 (2): 331–8. doi:10.1016/j.nurt.2008.01.004. PMC 5084174. PMID 18394574.
↑ Zaaroor M, Sinai A, Goldsher D, Eran A, Nassar M, Schlesinger I (2018). "Magnetic resonance-guided focused ultrasound thalamotomy for tremor: a report of 30 Parkinson's disease and essential tremor cases". J Neurosurg. 128 (1): 202–210. doi:10.3171/2016.10.JNS16758. PMID 28298022.
↑ Campbell AM, Glover J, Chiang VL, Gerrard J, Yu JB (2015). "Gamma knife stereotactic radiosurgical thalamotomy for intractable tremor: a systematic review of the literature". Radiother Oncol. 114 (3): 296–301. doi:10.1016/j.radonc.2015.01.013. PMID 25690750.