Surgical treatments for essential tremor

ABSTRACT

Introduction: Essential tremor is the most common form of pathologic tremor. Surgical therapies disrupt tremorogenic oscillation in the cerebellothalamocortical pathway and are capable of abolishing severe tremor that is refractory to available pharmacotherapies. Surgical methods are raspidly improving and are the subject of this review.

Areas covered: A PubMed search on 18 January 2018 using the query essential tremor AND surgery produced 839 abstracts. 379 papers were selected for review of the methods, efficacy, safety and expense of stereotactic deep brain stimulation (DBS), stereotactic radiosurgery (SRS), focused ultrasound (FUS) ablation, and radiofrequency ablation of the cerebellothalamocortical pathway.

Expert commentary: DBS and SRS, FUS and radiofrequency ablations are capable of reducing upper extremity tremor by more than 80% and are far more effective than any available drug. The main research questions at this time are: 1) the relative safety, efficacy, and expense of DBS, SRS, and FUS performed unilaterally and bilaterally; 2) the relative safety and efficacy of thalamic versus subthalamic targeting; 3) the relative safety and efficacy of atlas-based versus direct imaging tractography-based anatomical targeting; and 4) the need for intraoperative microelectrode recordings and macroelectrode stimulation in awake patients to identify the optimum anatomical target. Randomized controlled trials are needed.

KEYWORDS:

• Essential tremor
• functional neurosurgery
• deep brain stimulation
• focused ultrasound
• stereotactic radiosurgery
• thalamotomy

Acknowledgment

This paper was supported in part by a grant from the Illinois-Eastern Iowa District Kiwanis Neuroscience Foundation.

Declaration of interest

R Elble has performed consultant work for Biohaven, Cadent, Cavion, and Sage, and he was a paid reviewer of patient video exams in a study funded by InSightec. He serves on the medical advisory board of the International Essential Tremor Foundation. He is the Medical Director of Illinois-Eastern Iowa District Kiwanis Neuroscience Foundation, and he receives a research grant from this foundation. L Shih was a paid rater of patient video exams, a study funded by InSightec, and is a member of the medical advisory board of the International Essential Tremor Foundation. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

This paper was supported in part by a grant from the Illinois-Eastern Iowa District Kiwanis Neuroscience Foundation.