Outcome of Essential Tremors with Stereotactic Thalamotomy: Noble Art of Lesioning

Abstract

Objective: Objective of study is to identify the effects of Stereotactic thalamotomy of the nucleus ventral intermediate (VIM) for treatment of essential tremor.
 Material and Methods: This is a descriptive study.It was performed at NCCI, Karachi, duration of study was 7 years, from 2-10-2012 to 7-10-2019. Those patients were included who were with tremors refractory to medication, their duration of disease was > 3 years, and with grade 4 tremors. The thalamotomy was performed in all cases, and follow-up was conducted at 3, 6, and 12 months respectively. The success of the surgery was measured in the form of a reduction in medication number and reduction in dose >50% and by calculating the Essential Tremor Rating Assessment Scale (tetras).
 Results: Total of 26 patients were included. All patients showed remarkable improvement post-procedure at 12 month follow-up. 20 (77%) patient required no medications. In 6 (23%) patients, the dose of medication was reduced to less than half post-treatment. The tetras score showed marked improvement in all a patient; 4 (15%) patients who had grade 4 tremor, showed the symptoms of minimal tremors graded 0.5 on last visit 3rd visit. Side effect post-procedure were mild transient numbness on the contralateral side was observed in 11 (42.3%) patient, 1 (3.8%) patient had dysarthria.
 Conclusion: We concluded that stereostatic Ventral intermedius nucleus thalamotomy was effective in reducing tremor grades and improved all functionality with few mild side effects.

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“…The technique allows treatment of tumors that are usually inoperable due to location in difficult to access areas of brain, or those treated unsuccessfully by conventional neurosurgery radiation therapy and chemotherapy [3,4]. It is also indicated for patients not suitable for surgery due to illness or advanced age [5].…”