Tremor surgery: Difference between revisions
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==Overview== | ==Overview== | ||
[[Surgery]] is not first | [[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. | ||
==Surgery== | ==Surgery== | ||
*[[Botulinum]] [[neurotoxin]] [[injections]]: | *[[Botulinum]] [[neurotoxin]] [[injections]]: | ||
**It has shown improvement in [[patients]] with [[hand]] tremor, regardless of the [[etiology]]<ref name="pmid30029483">{{cite journal| author=Niemann N, Jankovic J| title=Botulinum Toxin for the Treatment of Hand Tremor. | journal=Toxins (Basel) | year= 2018 | volume= 10 | issue= 7 | pages= | pmid=30029483 | doi=10.3390/toxins10070299 | pmc=6070882 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30029483 }} </ref> | **It has shown improvement in [[patients]] with [[hand]] tremor, regardless of the [[etiology]]. <ref name="pmid30029483">{{cite journal| author=Niemann N, Jankovic J| title=Botulinum Toxin for the Treatment of Hand Tremor. | journal=Toxins (Basel) | year= 2018 | volume= 10 | issue= 7 | pages= | pmid=30029483 | doi=10.3390/toxins10070299 | pmc=6070882 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30029483 }} </ref> | ||
*[[Thalamotomy]]<ref name="pmid23154796">{{cite journal| author=Bahgat D, Magill ST, Berk C, McCartney S, Burchiel KJ| title=Thalamotomy as a treatment option for tremor after ineffective deep brain stimulation. | journal=Stereotact Funct Neurosurg | year= 2013 | volume= 91 | issue= 1 | pages= 18-23 | pmid=23154796 | doi=10.1159/000342491 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23154796 }} </ref> | *[[Thalamotomy|Thalamotomy:]] <ref name="pmid23154796">{{cite journal| author=Bahgat D, Magill ST, Berk C, McCartney S, Burchiel KJ| title=Thalamotomy as a treatment option for tremor after ineffective deep brain stimulation. | journal=Stereotact Funct Neurosurg | year= 2013 | volume= 91 | issue= 1 | pages= 18-23 | pmid=23154796 | doi=10.1159/000342491 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23154796 }} </ref> | ||
**Helpful in [[medication]] [[resistant]] [[essential tremor]], [[cerebellar]] tremor, or [[Parkinson's disease]] related tremor. | **Helpful in [[medication]]-[[resistant]] [[essential tremor]], [[cerebellar]] tremor, or [[Parkinson's disease]] related tremor. | ||
**Tremor is permanently treated by creating [[lesions]] in [[thalamus]] responsible for causing tremors. | **Tremor is permanently treated by creating [[lesions]] in the [[thalamus]] responsible for causing tremors. | ||
**Most common [[side effect]] | **Most common [[side effect]]s are [[dysarthria]], [[cognitive]] impairment, and imbalance. | ||
**It is an invasive [[procedure]]. | **It is an invasive [[procedure]]. | ||
*[[Deep brain stimulation]]<ref name="pmid18394574">{{cite journal| author=Lyons KE, Pahwa R| title=Deep brain stimulation and tremor. | journal=Neurotherapeutics | year= 2008 | volume= 5 | issue= 2 | pages= 331-8 | pmid=18394574 | doi=10.1016/j.nurt.2008.01.004 | pmc=5084174 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18394574 }} </ref> | *[[Deep brain stimulation|Deep brain stimulation:]] <ref name="pmid18394574">{{cite journal| author=Lyons KE, Pahwa R| title=Deep brain stimulation and tremor. | journal=Neurotherapeutics | year= 2008 | volume= 5 | issue= 2 | pages= 331-8 | pmid=18394574 | doi=10.1016/j.nurt.2008.01.004 | pmc=5084174 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18394574 }} </ref> | ||
**[[Parkinson's disease]] and [[essential tremor]] may benefit from [[deep brain stimulation]]. | **[[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]]. | **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): | *[[Magnetic resonance]]-guided focused [[ultrasound]] (MRgFUS): <ref name="pmid28298022">{{cite journal| author=Zaaroor M, Sinai A, Goldsher D, Eran A, Nassar M, Schlesinger I| title=Magnetic resonance-guided focused ultrasound thalamotomy for tremor: a report of 30 Parkinson's disease and essential tremor cases. | journal=J Neurosurg | year= 2018 | volume= 128 | issue= 1 | pages= 202-210 | pmid=28298022 | doi=10.3171/2016.10.JNS16758 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28298022 }} </ref> | ||
**[[Noninvasive]] [[thalamotomy]] procedure | **[[Noninvasive]] [[thalamotomy]] procedure uses [[thermal]] [[ablation]]. | ||
*[[Radio-surgical gamma knife]] [[thalamotomy]]<ref name="pmid25690750">{{cite journal| author=Campbell AM, Glover J, Chiang VL, Gerrard J, Yu JB| title=Gamma knife stereotactic radiosurgical thalamotomy for intractable tremor: a systematic review of the literature. | journal=Radiother Oncol | year= 2015 | volume= 114 | issue= 3 | pages= 296-301 | pmid=25690750 | doi=10.1016/j.radonc.2015.01.013 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25690750 }} </ref> | **Used in severe [[medication]]-[[resistant]] [[essential tremor]] or [[Parkinsonian]] tremor. | ||
**It is found to be safe if done unilaterally | **Most of the [[side effects]] reported did not last more than three months. | ||
**Optimum dose from 130 to 150Gy is well tolerated | *[[Radio-surgical gamma knife]] [[thalamotomy|thalamotomy:]] <ref name="pmid25690750">{{cite journal| author=Campbell AM, Glover J, Chiang VL, Gerrard J, Yu JB| title=Gamma knife stereotactic radiosurgical thalamotomy for intractable tremor: a systematic review of the literature. | journal=Radiother Oncol | year= 2015 | volume= 114 | issue= 3 | pages= 296-301 | pmid=25690750 | doi=10.1016/j.radonc.2015.01.013 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25690750 }} </ref> | ||
**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]]. | **Most common [[side effects]] are mild [[contralateral]] [[numbness]] and transient [[hemiparesis]]. | ||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
[[Category: | [[Category:Neurology]] | ||
[[Category:Primary care]] | |||
[[Category:Up-to-date]] | |||
Latest revision as of 19:59, 25 February 2021
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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.
Surgery
- Botulinum neurotoxin injections:
- 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.
References
- ↑ 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.