Revisiting bilateral thalamotomy for tremor

Clinical Neurology and Neurosurgery
Jumana Alshaikh, Paul S Fishman

Abstract

MRI guided focused ultrasound surgery (MRgFUS) has been FDA approved for unilateral treatment of essential tremor (ET). Before this non-incisional lesioning method can be applied to the treatment of both hemispheres the previous experience with bilateral thalamic ablation must be addressed. In particular, the high incidence of worsening of speech and balance associated with bilateral surgical thalamotomy, a rationale for the development of deep brain stimulation. The highest incidence of these complication occurred in the early years of surgery for movement disorders, when neither MRI nor current stereotactic methods were available. The vast majority of these initial patients suffering these complications had Parkinson's disease where approximately 30% developed worsening dysarthria and ataxia after bilateral thalamotomy. Patients suffering these complications commonly had baseline abnormalities in speech and balance or worsening symptoms after a first unilateral procedure. The more contemporary experience with bilateral thalamotomy in the ET population is both much more limited in patient numbers (includes patients after Gamma Knife radiosurgery), and shows a much lower rate of these complications (approximately 5%). This more...Continue Reading

Citations

Feb 25, 2018·Expert Review of Neurotherapeutics·Rodger J ElbleJeffrey W Cozzens
May 10, 2018·The New England Journal of Medicine·Dietrich Haubenberger, Mark Hallett
Apr 28, 2018·Movement Disorders : Official Journal of the Movement Disorder Society·Paul S FishmanHoward M Eisenberg
Oct 23, 2018·Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova·S V Vasechkin, O S Levin
Jul 14, 2020·Current Opinion in Neurology·Raúl Martínez-Fernández, José A Pineda-Pardo
Jul 11, 2019·Movement Disorders : Official Journal of the Movement Disorder Society·Shayan MoosaPaul S Fishman
Apr 29, 2021·Journal of Neurology, Neurosurgery, and Psychiatry·Raúl Martínez-FernándezJose A Obeso
Jul 4, 2021·Neurological Sciences : Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology·Yi GeZhong Wang
Jul 22, 2021·Movement Disorders : Official Journal of the Movement Disorder Society·Christian Iorio-MorinAndres M Lozano
Aug 13, 2021·Journal of Neuro-oncology·Lior Lev-TovVivek P Buch
Jul 3, 2021·Neurological Sciences : Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology·Navnika Gupta, Sanjay Pandey

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