• Common Movement Disorder
• It's a neurological condition that causes involuntary, rhythmic movement that may get worse over time
• Affects the arms and legs but the head, truck and voice can also be affected.  
• It can be extremely disabling affecting ones ability to write, drink from a cup or dress oneself

1) Medications:

• First types of medications that the doctor may prescribe includes propranolol, primidone and topiramate
• For additional medication information, click on the Medication Option button below.  Please share this information with your doctor

2) Surgery:

• If your medications do not control your tremor, than the doctor may recommend surgery, which may include Deep Brain Stimulation (DBS) or thalamotomy 

Surgical options include 

1) Deep Brain Stimulation (DBS): Electrical stimulation is applied through tiny electrodes implanted deep into the brain, in an area called the Vim nucleus of the thalamus.  It is this electrical stimulus that helps to control the tremor. It is most effective in treating hand and arm tremor, but can also help with head, leg and voice tremor.

2) Thalamotomy: Lesioning (means destroying/burning) the Vim nucleus of the thalamus also controls tremor. Thalamotomy can only be performed on one side of the brain, meaning only 1 hand can be treated.

a) Radiosurgical: Radiation is used to lesion the thalamus. Results are not immediate and take time to develop.  

b) Focused Ultrasound Thalamotomy: Also referred to as MRgFUS Thalamotomy or HIFU.  This was FDA approved in 2016.   Uses high intensity ultrasound to destroy the Vim nucleus of the thalamus that causes tremor.  

• It is an outpatient surgical procedure
• A permanent lesion is created in an area of the brain called the thalamus
• The lesion interrupts brain signals that control involuntary movements that helps to improve tremor in patients
• Lesion is created by using high intensity ultrasound (HIFU or MRgFUS) energy waves  and is done inside the MRI machine
• Patients will need to shave their head completely
• A local freezing will be applied to your skin and a head frame will be applied to your head to prevent it from moving during the procedure 
• A rubber bladder will be placed on the head to keep the skin and skull cool when the high temperatures are reached to create the lesion or sonication
• Temperatures can reach between 55-60 degrees Celsius during the sonications
• Several sonications are required in order to create the permanent lesion
• patients are awake during the sonications and can communicate with their health team and provide feedback on their tremor response. 

NOTE: It can only be done on one side of the brain.  As a result, only 1 side of the hand/arm can be treated. Other medications or surgical options will need to be considered for the other hand/arm at a later date. 

For a patient handout on MRgFUS, click here

• Surgical Risks:
  • Bleeding in the brain leading to stroke (<1%)
  • Infection at pin site (treated with antibiotic pills)
  • Nausea - vomiting
  • DVT (Deep Vein Thrombosis, requires 3-6 months of blood thinners)
• Possible side effects:
  • Early after the surgery:
    • Problems walking (36% of patients notice this)
    • Tingling, feeling pins-and-needles, or numbness (38% of patients)
    • Incoordination of arms or legs or both (20% of patients)
    • Feeling unsteady (16% of patients)
• • At one year after surgery some patients still report these side effects:
    • Problems walking (9% of patients)
    • Numbness/tingling (14% of patients)
    • Incoordination (4% of patients)
    • Feeling unsteady (5% of patients)

Helpful Patient handouts:

Patient Information: MR guided Focused Ultrasound Thalamotomy for Essential Tremor

A Patient's Guide to Exablate Neuro Trans-Cranial MR Guided Focused Ultrasound Surgery for Essential Tremor

Essential Tremor: Surgical Options

Essential Tremor Primary Care Pathway

If you would like more information about the Movement Disorders Clinic, click below