Surgical treatment of essential tremor
- Daniel Tarsy, MD
Daniel Tarsy, MD
- Professor of Neurology
- Harvard Medical School
- Ludy Shih, MD
Ludy Shih, MD
- Assistant Professor of Neurology
- Harvard Medical School
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.
This topic will review the surgical treatment of ET. The pharmacologic treatment of ET is discussed separately. (See "Essential tremor: Treatment and prognosis".)
The classification, clinical features, and diagnosis of ET are reviewed elsewhere. (See "Essential tremor: Clinical features and diagnosis".)
ET may represent a syndrome of related disorders rather than a single disease. A family history is present in 30 to 70 percent of patients with the disorder. No genes have been identified as the cause, but familial ET appears to follow an autosomal dominant inheritance pattern. ET is the most common neurologic disorder that causes postural or action tremor. It most often affects the hands and arms and can be asymmetric. Less often, ET can also involve the head, voice, chin, trunk, and legs.
The diagnosis of ET is based upon clinical features (table 1). The main considerations in the differential diagnosis of ET are parkinsonian tremor, tremor caused by cerebellar disorders, and dystonic tremor. (See "Essential tremor: Clinical features and diagnosis".)
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- APPROACH TO TREATMENT
- DEEP BRAIN STIMULATION
- Effectiveness of DBS for limb tremor
- Effectiveness of DBS for voice and head tremor
- Limitations of DBS
- Effectiveness of thalamotomy
- Limitations of thalamotomy
- Gamma knife thalamotomy
- Ultrasound thalamotomy
- COMPARISON OF THALAMOTOMY AND DBS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS