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 first line treatment for any cause of tremor. It is opted for once non-pharmacological and pharmacological therapy fails. Botulinum neurotoxin injections, thalamotomy, deep brain stimulation

Surgery

• Botulinum neurotoxin injections:
  • It has shown improvement in patients with hand tremor, regardless of the etiology.
• Thalamotomy:
  • 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.
  • Most common side effect is dysarthria, cognitive impairment, and imbalance.
  • It is an invasive procedure.
• 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. Downside of deep brain stimulation is the expense, and long term benefits are not established. It is reversible.
• Magnetic resonance-guided focused ultrasound (MRgFUS),
• Radio-surgical gamma knife thalamotomy.