Gamma Knife Thalamotomy for Disabling Tremor

Lim, Shen‐Yang; Hodaie, Mojgan; Fallis, Melanie; Poon, Yu‐Yan; Mazzella, Filomena; Moro, Elena

doi:10.1001/archneurol.2010.69

Cited by 83 publications

(58 citation statements)

References 15 publications

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“…For gamma knife thalamotomy controlled trials are scarce: 1 study [84] used blinded rating, but there are no placebo-(sham-) controlled trials. Two recent uncontrolled case series report conflicting results, with efficacy and risks comparable to Vim DBS in 1 [85,86], but only mild benefit in the other [84].…”

Section: Botulinum Toxin For Et Limb Tremormentioning

confidence: 99%

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The Treatment of Tremor

Schneider

Deuschl

2014

Neurotherapeutics

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Tremor is a hyperkinetic movement disorder characterized by rhythmic oscillations of one or more body parts. It can be disabling and may impair quality of life. Various etiological subtypes of tremor are recognized, with essential tremor (ET) and Parkinsonian tremor being the most common. Here we review the current literature on tremor treatment regarding ET and head and voice tremor, as well as dystonic tremor, orthostatic tremor, tremor due to multiple sclerosis (MS) or lesions in the brainstem or thalamus, neuropathic tremor, and functional (psychogenic) tremor, and summarize main findings. Most studies are available for ET and only few studies specifically focused on other tremor forms. Controlled trials outside ET are rare and hence most of the recommendations are based on a low level of evidence. For ET, propranolol and primidone are considered drugs of first choice with a mean effect size of approximately 50 % tremor reduction. The efficacy of topiramate is also supported by a large double-blind placebocontrolled trial, while other drugs have less supporting evidence. With a mean effect size of about 90 % deep brain stimulation in the nucleus ventralis intermedius or the subthalamic nucleus may be the most potent treatment; however, there are no controlled trials and it is reserved for severely affected patients. Dystonic limb tremor may respond to anticholinergics. Botulinum toxin improves head and voice tremor. Gabapentin and clonazepam are often recommended for orthostatic tremor. MS tremor responds only poorly to drug treatment. For patients with severe MS tremor, thalamic deep brain stimulation has been recommended. Patients with functional tremor may benefit from antidepressants and are best be treated in a multidisciplinary setting. Several tremor syndromes can already be treated with success. But new drugs specifically designed for tremor treatment are needed. ET is most likely covering different entities and their delineation may also improve treatment. Modern study designs and long-term studies are needed.

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Section: Botulinum Toxin For Et Limb Tremormentioning

confidence: 99%

“…Two recent uncontrolled case series report conflicting results, with efficacy and risks comparable to Vim DBS in 1 [85,86], but only mild benefit in the other [84]. The risk of uncontrolled long-term enlargement of the lesions has been described [84,87].…”

Section: Botulinum Toxin For Et Limb Tremormentioning

confidence: 99%

The Treatment of Tremor

Schneider

Deuschl

2014

Neurotherapeutics

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“…2,3 Delayed neurological events have been observed especially when involvement extends into the internal capsule. 4,7,9,14 Lastly, T2-weighted MRI signal change in the white matter beyond the stereotactic target, assumed to represent cerebral edema, could potentially represent radiation injury. 2,8 The authors suggest that radiosurgical effects become stronger over time and that radiofrequency ablations wane, but there is no current evidence that radiosurgical lesions are more durable once the perilesional edema has resolved.…”

mentioning

confidence: 99%

Editorial: Tremor

Elias¹

2013

JNS

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“…The main series in the literature report a good safety efficacy of GKS thalamotomy for tremor when practiced using a state-of-the-art set up (a single 4-mm shot, maximum dose between 130 and 160 Gy). Some series have reported less satisfactory results [33,34]. Okun et al [34] reported a high rate of toxicity; however the very high dose (maximum 200 Gy) used in these patients is much higher than that recommended in modern literature (120-140 Gy), which easily explains such an unusual rate of toxicity [34].…”

Section: Movement Disordersmentioning

confidence: 98%

Gamma Knife for Functional Diseases

Régis

2014

Neurotherapeutics

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Gamma Knife Thalamotomy for Disabling Tremor

Cited by 83 publications

References 15 publications

The Treatment of Tremor

The Treatment of Tremor

Editorial: Tremor

Gamma Knife for Functional Diseases

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