title: Surgery for Dystonia and Tremor.
abstract: Surgical procedures for dystonia and tremor have evolved over the past few decades, and our understanding of risk, benefit, and predictive factors has increased substantially in that time. Deep brain stimulation (DBS) is the most utilized surgical treatment for dystonia and tremor, though lesioning remains an effective option in appropriate patients. Dystonic syndromes that have shown a substantial reduction in severity secondary to DBS are isolated dystonia, including generalized, cervical, and segmental, as well as acquired dystonia such as tardive dystonia. Essential tremor is quite amenable to DBS, though the response of other forms of postural and kinetic tremor is not nearly as robust or consistent based on available evidence. Regarding targeting, DBS lead placement in the globus pallidus internus has shown marked efficacy in dystonia reduction. The subthalamic nucleus is an emerging target, and increasing evidence suggests that this may be a viable target in dystonia as well. The ventralis intermedius nucleus of the thalamus is the preferred target for essential tremor, though targeting the subthalamic zone/caudal zona incerta has shown promise and may emerge as another option in essential tremor and possibly other tremor disorders. In the carefully selected patient, DBS and lesioning procedures are relatively safe and effective for the management of dystonia and tremor.
authors.affiliation: Department of Neurology, University of Virginia, PO Box 800394, Charlottesville, VA, 22908, USA.
authors.forename: Jason L
authors.initials: JL
authors.lastname: Crowell
authors.affiliation: Department of Neurology, University of Virginia, PO Box 800394, Charlottesville, VA, 22908, USA. binitshah@virginia.edu.
authors.forename: Binit B
authors.initials: BB
authors.lastname: Shah
mesh_terms: D017668:Age of Onset; D046690:Deep Brain Stimulation; D004421:Dystonia / Q000601:surgery*; D006801:Humans; D019635:Neurosurgical Procedures / Q000379:methods; D016896:Treatment Outcome; D014202:Tremor / Q000601:surgery*
keywords: Deep brain stimulation; Dystonia; Pallidotomy; Surgical treatment dystonia; Surgical treatment tremor; Thalamotomy; Tremor
references.citation: Parkinsonism Relat Disord. 2014 Dec;20(12):1415-8
references.pmid: 25282319
references.citation: Eur J Neurol. 2012 May;19(5):764-8
references.pmid: 22248187
references.citation: J Neurol Neurosurg Psychiatry. 2012 Mar;83(3):258-62
references.pmid: 22205676
references.citation: Neurology. 2006 May 23;66(10):1556-8
references.pmid: 16717218
references.citation: J Neurol Neurosurg Psychiatry. 2015 Apr;86(4):404-9
references.pmid: 25012202
references.citation: J Neurosurg. 2007 Nov;107(5):977-82
references.pmid: 17977270
references.citation: Med Klin. 1977 Nov 18;72(46):1982-6
references.pmid: 337081
references.citation: N Engl J Med. 2006 Nov 9;355(19):1978-90
references.pmid: 17093249
references.citation: J Neurol Neurosurg Psychiatry. 2005 May;76(5):684-90
references.pmid: 15834027
references.citation: Tremor Other Hyperkinet Mov (N Y). 2014 Jul 09;4:228
references.pmid: 25120941
references.citation: Mov Disord. 2013 Oct;28(12):1661-7
references.pmid: 23861366
references.citation: Stereotact Funct Neurosurg. 2009;87(6):379-84
references.pmid: 19844137
references.citation: J Neurol Neurosurg Psychiatry. 2014 May;85(5):567-72
references.pmid: 24096713
references.citation: Acta Neurol Scand. 2008 Dec;118(6):387-94
references.pmid: 18616684
references.citation: Arch Neurol. 2008 Jan;65(1):101-7
references.pmid: 18195146
references.citation: N Engl J Med. 2013 Aug 15;369(7):640-8
references.pmid: 23944301
references.citation: Neurobiol Dis. 2011 May;42(2):177-84
references.pmid: 20817092
references.citation: Acta Neurochir (Wien). 2009 Jan;151(1):31-6
references.pmid: 19093072
references.citation: Stereotact Funct Neurosurg. 2010;88(2):105-8
references.pmid: 20134209
references.citation: Neurosurgery. 2012 Apr;70(4):840-5; discussion 845-6
references.pmid: 22426044
references.citation: Neurology. 2003 Dec 9;61(11):1601-4
references.pmid: 14663050
references.citation: N Engl J Med. 2001 Sep 20;345(12):887-91
references.pmid: 11565522
references.citation: Lancet Neurol. 2007 Mar;6(3):223-9
references.pmid: 17303528
references.citation: Brain. 2008 Feb;131(Pt 2):473-84
references.pmid: 18178569
references.citation: Mov Disord. 2013 Aug;28(9):1292-5
references.pmid: 23554137
references.citation: J Neurol Neurosurg Psychiatry. 2001 Apr;70(4):557-9
references.pmid: 11254790
references.citation: Neurology. 2007 Aug 14;69(7):681-8
references.pmid: 17698790
references.citation: Lancet Neurol. 2014 Sep;13(9):875-84
references.pmid: 25127231
references.citation: Ann Neurol. 2014 Jul;76(1):22-30
references.pmid: 24852850
references.citation: Eur J Neurol. 2012 Apr;19(4):610-5
references.pmid: 22117556
references.citation: Mov Disord. 2010 Aug 15;25(11):1550-9
references.pmid: 20623768
references.citation: N Engl J Med. 2000 Feb 17;342(7):461-8
references.pmid: 10675426
references.citation: Mov Disord. 2012 Oct;27(12):1559-63
references.pmid: 23038611
references.citation: J Neurol. 2003 Oct;250(10):1201-5
references.pmid: 14586602
references.citation: Neurology. 2005 Jan 25;64(2):344-6
references.pmid: 15668437
references.citation: J Neurol. 2001 Aug;248(8):695-700
references.pmid: 11569899
references.citation: Parkinsonism Relat Disord. 2015 Feb;21(2):116-9
references.pmid: 25465373
references.citation: J Neurol Neurosurg Psychiatry. 2011 Aug;82(8):899-904
references.pmid: 21285454
references.citation: Neurology. 2003 Mar 11;60(5):786-90
references.pmid: 12629234
references.citation: Mult Scler Relat Disord. 2014 Jul;3(4):431-9
references.pmid: 25877053
references.citation: Neurology. 2015 Mar 3;84(9):895-903
references.pmid: 25653290
references.citation: J Neurol Neurosurg Psychiatry. 2015 Aug;86(8):833-9
references.pmid: 25253870
references.citation: Neurology. 2006 Jan 10;66(1):142-3
references.pmid: 16401868
references.citation: Mov Disord. 2013 Jun 15;28(7):1013-20
references.pmid: 23893457
references.citation: Mov Disord. 2002;17 Suppl 3:S89-93
references.pmid: 11948761
references.citation: N Engl J Med. 2006 Aug 24;355(8):818-29
references.pmid: 16928997
references.citation: Stereotact Funct Neurosurg. 2009;87(1):37-44
references.pmid: 19174619
references.citation: J Neurol Neurosurg Psychiatry. 2005 Dec;76(12):1713-6
references.pmid: 16291900
references.citation: Acta Neurochir (Wien). 2007 Aug;149(8):749-58; discussion 758
references.pmid: 17660940
references.citation: J Neurol Neurosurg Psychiatry. 2010 Dec;81(12):1383-9
references.pmid: 20841370
references.citation: Mov Disord. 2013 Nov;28(13):1877-82
references.pmid: 23861342
references.citation: Arch Neurol. 2002 Mar;59(3):413-7
references.pmid: 11890845
references.citation: Neurology. 2004 Dec 14;63(11):2170-2
references.pmid: 15596774
references.citation: J Neurosurg. 1996 Feb;84(2):203-14
references.pmid: 8592222
references.citation: Neurotherapeutics. 2008 Apr;5(2):281-93
references.pmid: 18394570
references.citation: Lancet Neurol. 2006 Oct;5(10):864-72
references.pmid: 16987733
references.citation: Lancet. 2000 Jun 24;355(9222):2220-1
references.pmid: 10881900
references.citation: J Clin Neurosci. 2015 May;22(5):872-6
references.pmid: 25669119
references.citation: Mov Disord. 2011 Jun;26 Suppl 1:S63-78
references.pmid: 21692114
references.citation: Neurosurgery. 2004 Mar;54(3):613-19; discussion 619-21
references.pmid: 15028135
references.citation: Parkinsonism Relat Disord. 2011 Sep;17(8):617-20
references.pmid: 21676643
references.citation: Mov Disord. 2009 May 15;24(7):1048-53
references.pmid: 19353721
references.citation: Parkinsonism Relat Disord. 2014 Jan;20 Suppl 1:S118-22
references.pmid: 24262161
references.citation: Mov Disord. 2001 Jul;16(4):774-7
references.pmid: 11481713
references.citation: Exp Neurol. 2012 Oct;237(2):435-43
references.pmid: 22809566
references.citation: Stereotact Funct Neurosurg. 2004;82(2-3):80-3
references.pmid: 15305079
references.citation: Mov Disord. 2010 Jul 30;25(10):1350-6
references.pmid: 20544817
references.citation: Mov Disord. 2003 Mar;18(3):303-12
references.pmid: 12621634
references.citation: J Neurol. 2011 Aug;258(8):1469-76
references.pmid: 21365458
references.citation: Arch Neurol. 2001 Feb;58(2):218-22
references.pmid: 11176959
references.citation: Brain. 2013 Mar;136(Pt 3):761-9
references.pmid: 23423670
references.citation: Mov Disord. 2008 Dec 15;23(16):2357-62
references.pmid: 18759339
references.citation: J Paediatr Child Health. 2004 May-Jun;40(5-6):322-5
references.pmid: 15151592
references.citation: Neurosurgery. 2012 Mar;70(3):526-35; discussion 535-6
references.pmid: 21904267
references.citation: Brain. 2008 Jul;131(Pt 7):1895-902
references.pmid: 18567622
references.citation: Mov Disord. 2008 Jun 15;23(8):1146-53
references.pmid: 18442104
references.citation: Ann Neurol. 1997 Sep;42(3):292-9
references.pmid: 9307249
references.citation: Mov Disord. 2010 Apr 15;25(5):534-41
references.pmid: 20175185
references.citation: N Engl J Med. 2005 Feb 3;352(5):459-67
references.pmid: 15689584
references.citation: Neurology. 2011 Mar 8;76(10):870-8
references.pmid: 21383323
references.citation: J Neurosurg. 2006 Apr;104(4):506-12
references.pmid: 16619653
references.citation: J Psychiatr Res. 2007 Nov;41(9):801-3
references.pmid: 16962613
references.citation: Curr Opin Neurol. 2007 Aug;20(4):470-6
references.pmid: 17620884
references.citation: Brain. 2007 Nov;130(Pt 11):2879-86
references.pmid: 17905796
references.citation: J Neurosurg. 2004 Aug;101(2):189-94
references.pmid: 15309907
references.citation: J Neurosurg. 2013 Dec;119(6):1537-45
references.pmid: 24116723
references.citation: J Neurosurg. 2010 Jun;112(6):1311-7
references.pmid: 19895197
references.citation: Mov Disord. 2003 Feb;18(2):163-70
references.pmid: 12539209
references.citation: Mov Disord. 2013 Jun 15;28(7):863-73
references.pmid: 23649720
references.citation: J Neurosurg. 2009 Feb;110(2):201-7
references.pmid: 18821828
references.citation: J Neurosurg. 2003 Oct;99(4):708-15
references.pmid: 14567607
references.citation: Brain Lang. 2014 Jul;134:23-33
references.pmid: 24815947
references.citation: Neurology. 2011 Aug 2;77(5):483-8
references.pmid: 21775741
references.citation: Rinsho Shinkeigaku. 2012;52(11):891-5
references.pmid: 23196455
references.citation: Brain. 2011 Jul;134(Pt 7):2096-105
references.pmid: 21646329
references.citation: Neuromodulation. 2010 Jan;13(1):26-30
references.pmid: 21992761
references.citation: J Neurosurg. 2007 Jul;107(1):29-36
references.pmid: 17639870
references.citation: Acta Neurochir Suppl. 2013;117:47-51
references.pmid: 23652656
references.citation: N Engl J Med. 1960 Sep 1;263:441-4
references.pmid: 13811793
references.citation: Neurology. 2009 Jul 7;73(1):53-8
references.pmid: 19564584
references.citation: Stereotact Funct Neurosurg. 2010;88(2):98-104
references.pmid: 20197711
references.citation: Mov Disord. 2008 Oct 15;23(13):1929-31
references.pmid: 18785227
references.citation: Neurology. 2015 Nov 3;85(18):1562-8
references.pmid: 26446066
references.citation: Mov Disord Clin Pract. 2015 Jun;2(2):135-141
references.pmid: 27088112
references.citation: Mov Disord. 2014 Jun;29(7):953-9
references.pmid: 24752968
references.citation: Mov Disord. 1998;13 Suppl 3:119-25
references.pmid: 9827607
references.citation: Mov Disord. 2002 Jan;17(1):138-44
references.pmid: 11835451
references.citation: J Neurol Neurosurg Psychiatry. 2010 Jan;81(1):65-9
references.pmid: 19744963
references.citation: Childs Nerv Syst. 2007 Sep;23(9):1033-40
references.pmid: 17551738
references.citation: J Neurol Neurosurg Psychiatry. 2003 Oct;74(10):1387-91
references.pmid: 14570831
references.citation: Clin Neurol Neurosurg. 2014 Oct;125:131-6
references.pmid: 25128653
references.citation: J Neurosurg. 2014 Jan;120(1):132-9
references.pmid: 24236657
references.citation: Neurology. 2005 Jun 28;64(12):2008-20
references.pmid: 15972843
references.citation: BMC Neurol. 2014 Jun 05;14:120
references.pmid: 24903550
references.citation: Neurology. 2003 Jun 24;60(12):2017-8
references.pmid: 12821763
references.citation: Ann Neurol. 2005 May;57(5):738-41
references.pmid: 15852393