Surgical Treatment of Essential Tremors
When medications are not effective, one additional
option is surgery to
destroy the abnormal brain cells that are responsible for the tremors. These
cells are located deep in the brain in the thalamus in a bilateral structure
called the basal ganglia. There are several nuclei (collections of brain cells)
in the thalamus, but the one that is related to tremors is called the ventral
intermediate nucleus (VIN). The operation, thalamotomy, can be done by
conventional stereotatic surgery or by the use of a Gamma knife (which uses
radiation). Since there is one thalamus in each side of the brain, the
thalamotomy could be unilateral or bilateral. An additional option is by
brain stimulation (DBS) with implanted electrodes.
These techniques have proved to be very effective in some patients but are
not free of side effects. At the present time the following are accepted
- Unilateral thalamotomy is indicated when the tremor is predominant or
limited to the contralateral limb. It might also be indicated in disabling
bilateral limb tremor that is refractory to medication.
- Bilateral thalamotomy might be indicated in cases of severe bilateral
tremor; however, the frequency of the side effects is a limiting factor.
- Deep brain stimulation is also effective for reducing a contralateral
- Both approaches seem to be effective in the suppression of limb tremors.
DBS seems to have fewer post-operative complications, but requires more
monitoring and adjustments after the operation. The ultimate decision depends
upon the individual patient.
- There is conflicting information regarding the use of surgery or DBS for
the treatment of voice or head tremors.
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