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Surgical treatment of essential tremor

Daniel Tarsy, MD
Ludy Shih, MD
Section Editor
Howard I Hurtig, MD
Deputy Editor
John F Dashe, MD, PhD


Tremor is defined as a rhythmic and oscillatory movement of a body part with a relatively constant frequency and variable amplitude. It is caused by either alternating or synchronous contractions of antagonistic muscles. Tremor is the most common of all movement disorders, and essential tremor (ET) is the most common neurologic cause of postural or action tremor.

The criteria for ET and methods for distinguishing this from other tremors are shown in the tables (table 1 and table 2 and table 3). (See "Overview of tremor", section on 'Essential tremor'.)

Deep brain stimulation of the ventral intermediate nucleus of the thalamus and stereotactic thalamotomy appear to be effective treatments for severely disabling, medication-resistant ET.

This topic will review the surgical treatment of ET. The pharmacologic treatment of ET is discussed separately. (See "Treatment and prognosis of essential tremor".)

The classification, clinical features, and evaluation of the major types of tremor are discussed separately. (See "Overview of tremor".)


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Literature review current through: Nov 2016. | This topic last updated: Wed Sep 14 00:00:00 GMT 2016.
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  1. Zesiewicz TA, Elble R, Louis ED, et al. Practice parameter: therapies for essential tremor: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2005; 64:2008.
  2. Flora ED, Perera CL, Cameron AL, Maddern GJ. Deep brain stimulation for essential tremor: a systematic review. Mov Disord 2010; 25:1550.
  3. Blomstedt P, Sandvik U, Tisch S. Deep brain stimulation in the posterior subthalamic area in the treatment of essential tremor. Mov Disord 2010; 25:1350.
  4. Hubble JP, Busenbark KL, Wilkinson S, et al. Deep brain stimulation for essential tremor. Neurology 1996; 46:1150.
  5. Zesiewicz TA, Elble RJ, Louis ED, et al. Evidence-based guideline update: treatment of essential tremor: report of the Quality Standards subcommittee of the American Academy of Neurology. Neurology 2011; 77:1752.
  6. Koller W, Pahwa R, Busenbark K, et al. High-frequency unilateral thalamic stimulation in the treatment of essential and parkinsonian tremor. Ann Neurol 1997; 42:292.
  7. Pahwa R, Lyons KL, Wilkinson SB, et al. Bilateral thalamic stimulation for the treatment of essential tremor. Neurology 1999; 53:1447.
  8. Ondo W, Almaguer M, Jankovic J, Simpson RK. Thalamic deep brain stimulation: comparison between unilateral and bilateral placement. Arch Neurol 2001; 58:218.
  9. Carpenter MA, Pahwa R, Miyawaki KL, et al. Reduction in voice tremor under thalamic stimulation. Neurology 1998; 50:796.
  10. Taha JM, Janszen MA, Favre J. Thalamic deep brain stimulation for the treatment of head, voice, and bilateral limb tremor. J Neurosurg 1999; 91:68.
  11. Limousin P, Speelman JD, Gielen F, Janssens M. Multicentre European study of thalamic stimulation in parkinsonian and essential tremor. J Neurol Neurosurg Psychiatry 1999; 66:289.
  12. Ondo W, Jankovic J, Schwartz K, et al. Unilateral thalamic deep brain stimulation for refractory essential tremor and Parkinson's disease tremor. Neurology 1998; 51:1063.
  13. Koller WC, Lyons KE, Wilkinson SB, Pahwa R. Efficacy of unilateral deep brain stimulation of the VIM nucleus of the thalamus for essential head tremor. Mov Disord 1999; 14:847.
  14. Schuurman PR, Bosch DA, Bossuyt PM, et al. A comparison of continuous thalamic stimulation and thalamotomy for suppression of severe tremor. N Engl J Med 2000; 342:461.
  15. Akbostanci MC, Slavin KV, Burchiel KJ. Stereotactic ventral intermedial thalamotomy for the treatment of essential tremor: results of a series of 37 patients. Stereotact Funct Neurosurg 1999; 72:174.
  16. Niranjan A, Kondziolka D, Baser S, et al. Functional outcomes after gamma knife thalamotomy for essential tremor and MS-related tremor. Neurology 2000; 55:443.
  17. Young RF, Jacques S, Mark R, et al. Gamma knife thalamotomy for treatment of tremor: long-term results. J Neurosurg 2000; 93 Suppl 3:128.
  18. Lim SY, Hodaie M, Fallis M, et al. Gamma knife thalamotomy for disabling tremor: a blinded evaluation. Arch Neurol 2010; 67:584.
  19. Siderowf A, Gollump SM, Stern MB, et al. Emergence of complex, involuntary movements after gamma knife radiosurgery for essential tremor. Mov Disord 2001; 16:965.
  20. Okun MS, Stover NP, Subramanian T, et al. Complications of gamma knife surgery for Parkinson disease. Arch Neurol 2001; 58:1995.
  21. Ohye C, Higuchi Y, Shibazaki T, et al. Gamma knife thalamotomy for Parkinson disease and essential tremor: a prospective multicenter study. Neurosurgery 2012; 70:526.
  22. Kooshkabadi A, Lunsford LD, Tonetti D, et al. Gamma Knife thalamotomy for tremor in the magnetic resonance imaging era. J Neurosurg 2013; 118:713.
  23. Witjas T, Carron R, Krack P, et al. A prospective single-blind study of Gamma Knife thalamotomy for tremor. Neurology 2015; 85:1562.
  24. Lipsman N, Schwartz ML, Huang Y, et al. MR-guided focused ultrasound thalamotomy for essential tremor: a proof-of-concept study. Lancet Neurol 2013; 12:462.
  25. Elias WJ, Huss D, Voss T, et al. A pilot study of focused ultrasound thalamotomy for essential tremor. N Engl J Med 2013; 369:640.
  26. Elias WJ, Lipsman N, Ondo WG, et al. A Randomized Trial of Focused Ultrasound Thalamotomy for Essential Tremor. N Engl J Med 2016; 375:730.
  27. Louis ED. Treatment of Medically Refractory Essential Tremor. N Engl J Med 2016; 375:792.
  28. Pahwa R, Lyons KE, Wilkinson SB, et al. Comparison of thalamotomy to deep brain stimulation of the thalamus in essential tremor. Mov Disord 2001; 16:140.
  29. Tasker RR. Deep brain stimulation is preferable to thalamotomy for tremor suppression. Surg Neurol 1998; 49:145.