Surgery for essential tremor

Essential Tremor Overview

Essential tremor is one of the most frequent movement disorders. The disorder is in majority of cases hereditary and tends to progress over time. The first symptoms of essential tremor occur in later adulthood. People who are suffering from this disease have difficulties when holding arms up or while performing some of the fine activities such as eating or writing. In advanced stages tremor may affect other parts of the body including head and it can interfere in speech. Stressful situations, exhaustion and certain medications can increase the amplitude of tremor.

It is believed that tremor is caused by fluctuating electrical discharge in the brain. This consequently sends atypical signal to the muscles and tremor occurs. This is why the treatment is based on interruption of these abnormal signals.

Conventional Treatment of Essential Tremor

In mild cases patients do not require any kind of treatment. However, if there is considerable functional impairment there are different treatment modalities.

Non-medical treatment includes special activities such as weighting the limb. This can be performed by usage of wrist weights. This option can be effective in some patients and only partially reduce the symptoms. The patients are taught how to relax which is important especially in stressful situations. Exposure to stress intensifies tremor. If patient is taking certain medications that can cause tremor these need to be discontinued. Medications that are potential for tremor include lithium, corticosteroids, and some antidepressants.

Medicamentous therapy of tremor includes a few groups of medications and one specific therapy. Beta adrenergic blockers as well as anti-seizure medications are routinely used in essential tremor. The doctor will compare the benefit of these medications to potential side effects and decide whether the patient is supposed to use medications or they will cause some serious side effects and only partially reduce tremor. Specific treatment includes injections of botulinum toxin. These injections are administered in patients with intensive head tremor.

Surgery for Essential Tremor

Perfect candidates for surgery are those who cannot benefit from conventional treatment and who suffer from rather intensive symptoms.

Surgical lesion is performed in the ventral intermediate thalamus. This surgical approach has been used for a long time. The surgery is successful in almost 90% of all treated patients. This procedure is only performed in one hemisphere of the brain since, it can cause significant damage to certain structures and brain functions if both hemispheres are operated.

Deep brain stimulation is much safer and it can be performed bilaterally. This procedure is reversible and can be perfectly controlled. Deep brain stimulation can achieve desirable results with only few or even no complications at all.