Tremor surgery: Difference between revisions

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{{CMG}} {{AE}} {{ZMalik}}
{{CMG}} {{AE}} {{ZMalik}}
==Overview==
==Overview==
[[Surgery]] is not first line treatment for any cause of tremor. It is opted for once non-[[pharmacological]] and [[pharmacological]] [[therapy]] fails. [[Botulinum]] [[neurotoxin]] [[injections]], [[thalamotomy]], [[deep brain stimulation]], [[magnetic resonance]]-guided focused [[ultrasound]], and [[radio-surgical gamma knife]] [[thalamotomy]] are the most often used interventional procedures to treat tremors.
[[Surgery]] is not the first option in treating any cause of tremor. It is applied once non-[[pharmacological]] and [[pharmacological]] [[therapy]] fails. [[Botulinum]] [[neurotoxin]] [[injections]], [[thalamotomy]], [[deep brain stimulation]], [[magnetic resonance]]-guided focused [[ultrasound]], and [[radio-surgical gamma knife]] [[thalamotomy]] are the most common interventional procedures to treat tremors.


==Surgery==
==Surgery==


*[[Botulinum]] [[neurotoxin]] [[injections]]:
*[[Botulinum]] [[neurotoxin]] [[injections]]:
**It has shown improvement in [[patients]] with [[hand]] tremor, regardless of the [[etiology]]<ref name="pmid30029483">{{cite journal| author=Niemann N, Jankovic J| title=Botulinum Toxin for the Treatment of Hand Tremor. | journal=Toxins (Basel) | year= 2018 | volume= 10 | issue= 7 | pages=  | pmid=30029483 | doi=10.3390/toxins10070299 | pmc=6070882 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30029483  }} </ref>.
**It has shown improvement in [[patients]] with [[hand]] tremor, regardless of the [[etiology]]. <ref name="pmid30029483">{{cite journal| author=Niemann N, Jankovic J| title=Botulinum Toxin for the Treatment of Hand Tremor. | journal=Toxins (Basel) | year= 2018 | volume= 10 | issue= 7 | pages=  | pmid=30029483 | doi=10.3390/toxins10070299 | pmc=6070882 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30029483  }} </ref>
*[[Thalamotomy]]<ref name="pmid23154796">{{cite journal| author=Bahgat D, Magill ST, Berk C, McCartney S, Burchiel KJ| title=Thalamotomy as a treatment option for tremor after ineffective deep brain stimulation. | journal=Stereotact Funct Neurosurg | year= 2013 | volume= 91 | issue= 1 | pages= 18-23 | pmid=23154796 | doi=10.1159/000342491 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23154796  }} </ref>:
*[[Thalamotomy|Thalamotomy:]] <ref name="pmid23154796">{{cite journal| author=Bahgat D, Magill ST, Berk C, McCartney S, Burchiel KJ| title=Thalamotomy as a treatment option for tremor after ineffective deep brain stimulation. | journal=Stereotact Funct Neurosurg | year= 2013 | volume= 91 | issue= 1 | pages= 18-23 | pmid=23154796 | doi=10.1159/000342491 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23154796  }} </ref>  
**Helpful in [[medication]] [[resistant]] [[essential tremor]], [[cerebellar]] tremor, or [[Parkinson's disease]] related tremor.  
**Helpful in [[medication]]-[[resistant]] [[essential tremor]], [[cerebellar]] tremor, or [[Parkinson's disease]] related tremor.
**Tremor is permanently treated by creating [[lesions]] in [[thalamus]] responsible for causing tremors.
**Tremor is permanently treated by creating [[lesions]] in the [[thalamus]] responsible for causing tremors.
**Most common [[side effect]] is [[dysarthria]], [[cognitive]] impairment, and imbalance.
**Most common [[side effect]]s are [[dysarthria]], [[cognitive]] impairment, and imbalance.
**It is an invasive [[procedure]].
**It is an invasive [[procedure]].
*[[Deep brain stimulation]]<ref name="pmid18394574">{{cite journal| author=Lyons KE, Pahwa R| title=Deep brain stimulation and tremor. | journal=Neurotherapeutics | year= 2008 | volume= 5 | issue= 2 | pages= 331-8 | pmid=18394574 | doi=10.1016/j.nurt.2008.01.004 | pmc=5084174 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18394574  }} </ref>:
*[[Deep brain stimulation|Deep brain stimulation:]] <ref name="pmid18394574">{{cite journal| author=Lyons KE, Pahwa R| title=Deep brain stimulation and tremor. | journal=Neurotherapeutics | year= 2008 | volume= 5 | issue= 2 | pages= 331-8 | pmid=18394574 | doi=10.1016/j.nurt.2008.01.004 | pmc=5084174 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18394574  }} </ref>  
**[[Parkinson's disease]] and [[essential tremor]] may benefit from [[deep brain stimulation]].
**[[Parkinson's disease]] and [[essential tremor]] may benefit from [[deep brain stimulation]].
**In this non-invasive procedure [[electrodes]] are [[implanted]] to send high-[[frequency]] [[electrical]] signals to the [[thalamus]], [[substantia nigra]], or [[globus pallidus]]. Downside of [[deep brain stimulation]] is the expense, and long term benefits are not established. It is reversible.
**In this non-invasive procedure, [[electrodes]] are [[implanted]] to send high-[[frequency]] [[electrical]] signals to the [[thalamus]], [[substantia nigra]], or [[globus pallidus]]. The downside of [[deep brain stimulation]] is the expense, and long-term benefits are not established. It is reversible.
*[[Magnetic resonance]]-guided focused [[ultrasound]] (MRgFUS):
*[[Magnetic resonance]]-guided focused [[ultrasound]] (MRgFUS): <ref name="pmid28298022">{{cite journal| author=Zaaroor M, Sinai A, Goldsher D, Eran A, Nassar M, Schlesinger I| title=Magnetic resonance-guided focused ultrasound thalamotomy for tremor: a report of 30 Parkinson's disease and essential tremor cases. | journal=J Neurosurg | year= 2018 | volume= 128 | issue= 1 | pages= 202-210 | pmid=28298022 | doi=10.3171/2016.10.JNS16758 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28298022  }} </ref>
**[[Noninvasive]] [[thalamotomy]] procedure, uses [[thermal]] [[ablation]].
**[[Noninvasive]] [[thalamotomy]] procedure uses [[thermal]] [[ablation]].
**Used in severe [[medication]]-[[resistant]] [[essential tremor]] or [[Parkinsonian]] tremor.
**Used in severe [[medication]]-[[resistant]] [[essential tremor]] or [[Parkinsonian]] tremor.
*[[Radio-surgical gamma knife]] [[thalamotomy]]<ref name="pmid25690750">{{cite journal| author=Campbell AM, Glover J, Chiang VL, Gerrard J, Yu JB| title=Gamma knife stereotactic radiosurgical thalamotomy for intractable tremor: a systematic review of the literature. | journal=Radiother Oncol | year= 2015 | volume= 114 | issue= 3 | pages= 296-301 | pmid=25690750 | doi=10.1016/j.radonc.2015.01.013 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25690750  }} </ref>:
**Most of the [[side effects]] reported did not last more than three months.
**It is found to be safe if done unilaterally
*[[Radio-surgical gamma knife]] [[thalamotomy|thalamotomy:]] <ref name="pmid25690750">{{cite journal| author=Campbell AM, Glover J, Chiang VL, Gerrard J, Yu JB| title=Gamma knife stereotactic radiosurgical thalamotomy for intractable tremor: a systematic review of the literature. | journal=Radiother Oncol | year= 2015 | volume= 114 | issue= 3 | pages= 296-301 | pmid=25690750 | doi=10.1016/j.radonc.2015.01.013 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25690750  }} </ref>
**Optimum dose from 130 to 150Gy is well tolerated
**It is found to be safe if done unilaterally.
**Optimum dose from 130 to 150Gy is well tolerated.
**Most common [[side effects]] are mild [[contralateral]] [[numbness]] and transient [[hemiparesis]].
**Most common [[side effects]] are mild [[contralateral]] [[numbness]] and transient [[hemiparesis]].


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
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Latest revision as of 19:59, 25 February 2021

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Zehra Malik, M.B.B.S[2]

Overview

Surgery is not the first option in treating any cause of tremor. It is applied once non-pharmacological and pharmacological therapy fails. Botulinum neurotoxin injections, thalamotomy, deep brain stimulation, magnetic resonance-guided focused ultrasound, and radio-surgical gamma knife thalamotomy are the most common interventional procedures to treat tremors.

Surgery

References

  1. Niemann N, Jankovic J (2018). "Botulinum Toxin for the Treatment of Hand Tremor". Toxins (Basel). 10 (7). doi:10.3390/toxins10070299. PMC 6070882. PMID 30029483.
  2. Bahgat D, Magill ST, Berk C, McCartney S, Burchiel KJ (2013). "Thalamotomy as a treatment option for tremor after ineffective deep brain stimulation". Stereotact Funct Neurosurg. 91 (1): 18–23. doi:10.1159/000342491. PMID 23154796.
  3. Lyons KE, Pahwa R (2008). "Deep brain stimulation and tremor". Neurotherapeutics. 5 (2): 331–8. doi:10.1016/j.nurt.2008.01.004. PMC 5084174. PMID 18394574.
  4. Zaaroor M, Sinai A, Goldsher D, Eran A, Nassar M, Schlesinger I (2018). "Magnetic resonance-guided focused ultrasound thalamotomy for tremor: a report of 30 Parkinson's disease and essential tremor cases". J Neurosurg. 128 (1): 202–210. doi:10.3171/2016.10.JNS16758. PMID 28298022.
  5. Campbell AM, Glover J, Chiang VL, Gerrard J, Yu JB (2015). "Gamma knife stereotactic radiosurgical thalamotomy for intractable tremor: a systematic review of the literature". Radiother Oncol. 114 (3): 296–301. doi:10.1016/j.radonc.2015.01.013. PMID 25690750.