High-frequency unilateral thalamic stimulation in the treatment of essential and Parkinsonian tremor

William Koller, Rajesh Pahwa, Karen Busenbark, Jean Hubble, Steve Wilkinson, Anthony Lang, Paul Tuite, Elspeth Sime, Andres Lazano, Robert Hauser, Teresita Malapira, Donald Smith, Daniel Tarsy, Edison Miyawaki, Thorkild Norregaard, Theresa Kormos, C. Warren Olanow

Research output: Contribution to journalArticlepeer-review

401 Scopus citations

Abstract

Pharmacologic treatment for essential tremor and the tremor of Parkinson's disease is often inadequate. Stereotaxic surgery, such as thalamotomy, can effectively reduce tremors. We performed a multicenter trial of unilateral high-frequency stimulation of the ventral intermedius nucleus of the thalamus in 29 patients with essential tremor and 24 patients with Parkinson's disease, using a blinded assessment at 3 months after surgery to compare clinical rating of tremor with stimulation ON with stimulation OFF and baseline and a 1-year follow-up. Six patients were not implanted because of lack of intraoperative tremor suppression (2 patients), hemorrhage (2 patients), withdrawal of consent (1 patient), and persistent microthalamotomy effect (1 patient). A significant reduction in both essential and parkinsonian tremor occurred contralaterally with stimulation. Patients reported a significant reduction in disability. Measures of function were significantly improved in patients with essential tremor. Complications related to surgery in implanted patients were few. Stimulation was commonly associated with transient paresthesias. Other adverse effects were mild and well tolerated. Efficacy was not reduced at 1 year. Chronic high-frequency stimulation is safe and highly effective in ameliorating essential and parkinsonian tremor.

Original languageEnglish (US)
Pages (from-to)292-299
Number of pages8
JournalAnnals of Neurology
Volume42
Issue number3
DOIs
StatePublished - Sep 1997

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