title: Essential tremor leading to toxic liver damage successfully treated with deep brain stimulation.
abstract: OBJECTIVE
  We present a patient with severe essential tremor (ET), who underwent thalamic deep brain stimulation (DBS). After previous medical treatment with Propranolol and Primidone failed, the patient resorted to alcohol, which greatly alleviated the symptoms. The downside of this situation, however, was that it led to alcoholism with severely disturbed liver enzymes and hepatic steatosis.
  
  
  RESULTS
  After DBS the patient was free of tremor and thus could easily abstain from alcohol.
  
  
  CONCLUSIONS
  In time the elevated liver enzymes returned to normal, which indicates that sufficient tremor control by DBS can help these patients to abstain from alcohol.
authors.affiliation: Department of Neurology, Klinikum Grosshadern, Ludwig-Maximilians University, Marchioninistr 15, 81377 Munich, Germany. jlevin@med.uni-muenchen.de
authors.forename: Johannes
authors.initials: J
authors.lastname: Levin
authors.forename: Jan
authors.initials: J
authors.lastname: Mehrkens
authors.forename: Alexander
authors.initials: A
authors.lastname: Gerbes
authors.forename: Kai
authors.initials: K
authors.lastname: Bötzel
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000437:Alcoholism / Q000150:complications* / Q000209:etiology; D000927:Anticonvulsants / Q000627:therapeutic use; D002492:Central Nervous System Depressants / Q000009:adverse effects* / Q000627:therapeutic use; D046690:Deep Brain Stimulation / Q000379:methods*; D020329:Essential Tremor / Q000503:physiopathology / Q000628:therapy*; D000431:Ethanol / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging / Q000187:drug effects / Q000503:physiopathology; D008108:Liver Diseases, Alcoholic / Q000473:pathology / Q000503:physiopathology*; D008297:Male; D009434:Neural Pathways / Q000502:physiology; D019635:Neurosurgical Procedures; D011324:Primidone / Q000627:therapeutic use; D011433:Propranolol / Q000627:therapeutic use; D013238:Stereotaxic Techniques; D017211:Treatment Failure; D016896:Treatment Outcome; D014463:Ultrasonography; D020651:Ventral Thalamic Nuclei / Q000033:anatomy & histology / Q000502:physiology / Q000601:surgery
chemical_list: D000319:Adrenergic beta-Antagonists; D000927:Anticonvulsants; D002492:Central Nervous System Depressants; D011324:Primidone; D000431:Ethanol; D011433:Propranolol