Essential Tremor

What is essential tremor?

Essential tremor causes shaking of the hands (one or both), particularly when performing everyday tasks. It can also involve the head and neck, voice, and sometimes the legs.

Essential tremor occurs mainly in the elderly, but may occur in young people. In many cases it may be inherited.

Essential tremor is often treatable with surgery.

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How is it treated?

Essential tremor is treated in the first instance with medications, such as beta-blockers. These are often effective. Unfortunately, the effectiveness of such medications may decrease over a number of years.

When medications are no longer providing adequate benefit, surgery may be of value. Most commonly, the type of surgery used to treat Essential tremor is deep brain stimulation (DBS).

What are the alternatives to surgery?

At present, the only alternatives to surgery are medications. You should check with your neurologist to ensure that you have tried all of the appropriate medications before seriously considering surgery.

Who may benefit from surgery?

Surgery, or deep brain stimulation, can significantly improve the quality of life for patients with Essential Tremor who have failed optimal medical therapy. However, these operations are not suitable for all patients and thorough assessments must be carried out to ensure that the likely benefits of surgery outweigh the risks.

What are the reasons for surgery?

When medications are no longer working well or their side effects are to severe, surgery may be of value.

What happens before surgery?

A number of weeks before surgery you will undergo an MRI scan of your brain. You will also be seen by a neuropsychologist, clinical psychologist, and movement disorder neurologist. The Precision team will arrange all of this for you.

What do you need to tell the doctor before surgery?

It is important that you tell your surgeon if you:

  • Have blood clotting or bleeding problems
  • Are taking aspirin, warfarin, or anything else (even some herbal supplements) that might thin your blood
  • Have high blood pressure
  • Have any allergies
  • Have any other health problems

What is deep brain stimulation?

Deep brain stimulation works by implanting fine wires (electrodes) into a specific portion of the brain. This was originally known as thalamic DBS or ‘Vim stim’, and initially targeted the thalamus, which is a major relay station deep within the brain.

In recent years, many surgeons have been using another area, the posterior subthalamic area (PSA) as the target for deep brain stimulation in essential tremor. Our experience with DBS in the PSA has been extremely encouraging and this is now our preferred target.