Stereotactic radiosurgery for essential tremor: Retrospective analysis of a 19‐year experience

ABSTRACT Background: Essential Tremor (ET) is a common movement disorder that can be disabling. Initial treatment is in the form of medical therapies. Patients with medically refractory ET seek surgical intervention which include radiofrequency thalamotomy, deep brain stimulation, and radiosurgical...

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Bibliographic Details
Published in:Movement disorders 2017-05, Vol.32 (5), p.769-777
Main Authors: Niranjan, Ajay, Raju, Sudesh S., Kooshkabadi, Ali, Monaco, Edward, Flickinger, John C., Lunsford, L. Dade
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Deep brain stimulation
Drinking
essential
Essential Tremor - diagnostic imaging
Essential Tremor - physiopathology
Essential Tremor - radiotherapy
Female
gamma knife
Geriatrics
Handwriting
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Motor task performance
Movement disorders
Neuroimaging
Radiosurgery
Radiosurgery - methods
Retrospective Studies
Severity of Illness Index
thalamotomy
Thalamus - diagnostic imaging
Treatment Outcome
Tremor
Ventral Thalamic Nuclei - diagnostic imaging
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Summary:ABSTRACT Background: Essential Tremor (ET) is a common movement disorder that can be disabling. Initial treatment is in the form of medical therapies. Patients with medically refractory ET seek surgical intervention which include radiofrequency thalamotomy, deep brain stimulation, and radiosurgical thalamotomy. Radiosurgical thalamotomy is a minimally invasive surgical option which is especially valuable for elderly and high surgical risk patients. Objective: The purpose of this study was to retrospectively analyze the outcomes of stereotactic radiosurgery for patients suffering from medically refractory essential tremor. Methods: During a 19‐year period (1996–2015), 73 patients underwent gamma knife thalamotomy for intractable essential tremor. A median central dose of 140 Gy (range, 130–150) was delivered to the nucleus ventralis intermedius through a single 4‐mm isocenter. We used the Fahn‐Tolosa‐Marin clinical tremor rating scale to score tremor, handwriting, drawing, and ability to drink fluids. The median time to last follow‐up was 28 months (range, 6–152). Results: After gamma knife thalamotomy, 93.2% improved in tremor. Forty‐four patients (60.3%) experienced tremor arrest or barely perceptible tremor. Eighteen patients (24.7%) noted tremor arrest and complete restoration of motor function. Tremor improvement was sustained at last follow‐up in 96% of patients who experience tremor relief. Mean tremor score improved from 3.19 before to 1.27 after gamma knife thalamotomy (P 
ISSN:0885-3185
1531-8257
DOI:10.1002/mds.26925