Introduction

Essential Heterogenous entity

Tremor
Prevalence 0,5%-5%

Kinetic, intention and postural tremor

 upper extremities
Introduction

Essential Difficulty with everyday tasks such as eating, drinking, handwriting and
dressing
Tremor
Social embarrassment regarding tremor

Medical treatment
1. Non surgical  beta-blocker, primidone
2. Surgical  DBS, RF Thalamotomy, Gamma knife, FUS thalamotomy
Methods

Primary Objective
• Sssessment of effi- cacy and safety of the different
modalities in the treatment

Secondary Objective
• Assessment of the treatment outcome on the activ-
ities of daily living (ADLs) and the quality of life
Results
Comparison
of surgical
outcome
Comparison of procedural details
Diagram of
dentatorubrothalamic tract
Discussion
Comparative Studies
Schuurman et al Pahwa et al
• RF vs DBS for severe tremor • RF vs DBS
• No significant differences between • No differences in tremor outcome
two groups in short terms score after short term follow up
• Adverse effect RF > DBS (2.2-3.1 months)
• 5 Years follow up  both were • Surgical complication 
effective, although effects of thalamotomy > DBS
stimulation decreased at later
time points
 Surgical
recommendation
(Patient Factors)
 Advance in DBS device technology 
improvement of the drawbacks
• Additional lead contacts and directional electrical
currents  Selective electrical fields to interact

Future
with the target brain structures  Maximise
benefits and minimizing adverse effect

Direction Advance in neuroimaging allow more

precise visualization
• Diffusion tensor imaging (DTI) can be used to map
large white matter tracts such as the internal
capsule, medial lemniscus and dentatoru-
brothalamic tract
 Choosing surgical modalities
• merits vs drawbacks
• Patients selection

Treatment of choice  DBS

RF vs DBS
Conclusion • Same effect for tremor
• Complication  RF > DBS

FUS thalamotomy
• Newest modality
• Immediate effect
• Tremor reccurencene
• Adverse effects  high incidence of paraesthesia and gait
disturbance
Thank You