Clinical Analysis of Stereotactic Thalamotomy for Medically Intractable Essential Tremor

ABSTRACT

Stereotactic ventrolateral thalamotomy has been successful in treating a wide spectrum of involuntary movement disorders. But very little has been reported concerning their application in essential tremor. Twenty three patients with medically refractory disabling essential tremor underwent ventralis(VL) thalamotomies. The procedure was unilateral in twenty three cases. Contralateral tremor remained abscent or markedly reduced in 22 patients at the time of the most recent follow-up examinations at a mean of 2.9 months after surgery. Disability was determined by a modified form of an estabilished rating scale for termor reported by Fahn and was reduced from a mean score of 11 to 3(p<0.0001) after the operation. Persistent surgical morbidity was limited to three patients with mild dysarthria and two with a mild cognitive impairment. There were no surgically related deaths. It is concluded that stereotactic VL thalamotomy is a treatment option for medically intractable disabling essential tremor.