Efficacy of Thalamotomy and Thalamic Deep Brain Stimulation for the Treatment of Head Tremor.

Choi, Seung Jin; Lee, Kyung Jin; Ji, Cheol; Ahn, Jae Geun; Choi, Hyun Chul; Kim, Moon Chan

Original Article

Journal of Korean Neurosurgical Society 2005;37(5): 325-328.

Seung Jin Choi, Kyung Jin Lee, Cheol Ji, Jae Geun Ahn, Hyun Chul Choi, Moon Chan Kim

¹Department of Neurosurgery, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea. sjinchoi88@hotmail.com
²Department of Neurosurgery, St. Mary Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

ABSTRACT

OBJECTIVE
Stereotactic thalamic procedure is well known to be a effective treatment for disabling upper limb tremor of essential tremor. However, the effect of this procedure for head tremor, which is midline symptom of that disease entity, has not been sufficiently established. The authors discuss the result of stereotactic thalamic operations for head tremor of their patients who suffered from essential tremor. METHODS: We evaluated 4 patients of essential tremor who had head tremor combined with both upper limb tremor. One patient underwent unilateral ventralis intermedius thalamotomy, two patients had unilateral Vim deep brain stimulation(DBS) and one patient had unilateral Vim thalamotomy and contralateral DBS. Postoperative results of tremor were evaluated using our proposed scale. RESULTS: Contralateral upper limb tremors to surgical side were markedly resolved in all patients but there was no meaningful effect for head tremor in 3 patients who underwent unilateral thalamic surgery. In a patient having simultaneously unilateral thalamotomy and contralateral DBS, remarkable improvement of head tremor was observed.
CONCLUSION
Although it is difficult to evaluate the efficacy of thalamic surgery for axial symptom of essential tremor with a few cases, simultaneous unilateral thalamotomy and contralateral DBS would be expected to induce favorable outcomes for head tremor with significant economical advantages.

Key Words: Deep brain stimulation; Essential tremor; Head tremor; Thalamotomy