The most common tremor disorder. When a hand tremor makes everyday tasks difficult and medication no longer helps, surgery targeting one small thalamic nucleus can substantially reduce or abolish it.
What it is
A tremor of action, not rest
Essential tremor is a rhythmic, involuntary shaking that appears with movement, when the hands are doing something such as writing, eating, or holding a cup, and may also affect the head or voice. This is different from the tremor of Parkinson's disease, which is typically present at rest. Essential tremor is often mild, but for some people it becomes severe enough to interfere with daily life and independence.
When surgery is considered
When medication is no longer enough
First-line treatment is medication. Surgery is considered when a disabling tremor no longer responds adequately to those medicines or when their side effects are not tolerable, and the tremor is significantly affecting daily function.
How it can help
Surgical options
All of these target the same small relay station for tremor in the thalamus, the VIM nucleus, in different ways.
VIM deep brain stimulation
Adjustable electrodes in the VIM nucleus of the thalamus deliver stimulation that is highly effective for essential tremor. It can be tuned over time and used on both sides, and because nothing is destroyed it can be adjusted or switched off.
MR-guided focused ultrasound thalamotomy
Hundreds of ultrasound beams converge to make a precise lesion in the VIM nucleus with no incision and no implant, under real-time MRI thermometry. It reduces tremor in the treated hand and is typically performed on one side.
Thalamotomy by radiofrequency or radiosurgery
A precise lesion in the VIM nucleus made by a stereotactically placed probe (radiofrequency) or by focused radiation (Gamma Knife), for selected patients, usually on one side.
Stimulation or a lesion?
Stimulation is adjustable and can treat both hands but uses an implanted device; a focused-ultrasound or radiofrequency lesion needs no hardware but is permanent and usually treats one side. The right choice depends on whether one or both hands are affected and on your preferences.