Stereotactic thalamotomy in the treatment of essential tremor of the upper extremity: Reassessment including a blinded measure of outcome

A. Zirh, S. G. Reich, P. M. Dougherty, F. A. Lenz

Research output: Contribution to journalArticlepeer-review

Abstract

The effectiveness of high frequency stimulation of the thalamic nucleus ventralis intermedius (Vim-HFS) for treatment of tremor has been studied by blinded assessment. The effectiveness of thalamotomy for essential tremor of the upper extremity by use of a blinded measure of outcome is now reported. Thalamotomy was performed in 21 patients (three operated on bilaterally) with medically intractable, essential tremor. Assessments of function, handwriting/drawing, and tremor amplitude were done before and at 3 and 12 months after surgery. The handwriting/drawing score was rated by a neurologist blinded to patient identity, laterality, and operative status. By comparison with baseline, both the total functional score and the total score from blinded assessment of handwriting/drawing improved significantly at 3 and 12 months after surgery. The two scores were significantly correlated, suggesting that the blinded assessment is a good predictor of a total disability from tremor. Complications after unilateral thalamotomy included transient dysarthria, permanent perioral numbness, and permanent mild disequilibrium in one patient each. Permanent mild dysarthria occurred in two of three patients operated bilaterally. Thus a blinded assessment of outcome establishes that unilateral thalamotomy is an effective, safe procedure for the treatment of essential tremor.

Original languageEnglish (US)
Pages (from-to)772-775
Number of pages4
JournalJournal of Neurology Neurosurgery and Psychiatry
Volume66
Issue number6
DOIs
StatePublished - Jun 1999

Keywords

  • Blinded assessment
  • Essential tremor
  • Microelectrode recording
  • Thalamotomy

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology
  • Psychiatry and Mental health

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