[Stereotactic ventrolateral thalamotomy in the treatment of essential tremor].
OBJECTIVE
Essential tremor is the most common tremorogenic movement disorder. In the majority of patients the progression of the disease is slow and the pharmacological treatment effectively alleviates tremor. In rare cases of increased essential tremor the surgical treatment (ventrolateral thalamotomy) is indicated. The goal of this study was to assess the effectiveness of unilateral thalamotomy in the treatment of essential tremor.


METHODS
10 stereotactic ventrolateral thalamotomies were performed in 9 patients for pharmacologically intractable essential tremor. Right thalamotomy was done in 5 patients and left thalamotomy in 4 patients. The study included five men and four women. Patients were assessed according to the Clinical Rating Scale for Tremor (CRST) before surgery and at 3, 12 and 24 months after thalamotomy.


RESULTS
In the postoperative period there was a marked reduction of essential tremor in the contralateral arm and, to a lower extent, in the contralateral leg. The mean presurgery value for contralateral upper extremity postural tremor (scores 5/6 CRST) decreased from 3.5 to mean postsurgery value of 0.6. The tremor reduction contributed to 59% improvement in specific motor tasks of upper extremities (Part B of CRST) at 2 years follow-up. There was also improvement of functional disabilities (Part C of CRST) by 62% when compared to preoperative value 2 years postoperatively.


CONCLUSIONS
Ventrolateral thalamotomy is a highly effective method in the treatment of essential tremor. The side effects related to surgery are rare and most of them are transient.
Sobstyl
Michał
M
Klinika Neurochirurgii, CMKP, Wojewódzki Szpital Bródnowski, ul. Kondratowicza 8, 03-232 Warszawa.
Zabek
Mirosław
M
Koziara
Henryk
H
Kadziołka
Bartosz
B
Mossakowski
Zbigniew
Z
D000328:Adult; D020329:Essential Tremor / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013238:Stereotaxic Techniques; D013788:Thalamus / Q000601:surgery*; D016896:Treatment Outcome