Surgery may be recommended when essential tremor is so severe that it causes disability. Thalamotomy is destruction of a portion of the area deep within the brain that receives sensory messages (thalamus). This procedure relieves essential tremor on one side of the body in approximately 75 percent of cases. Surgery on both sides of the thalamus rarely is performed because of the high risk for speech loss.
Deep brain stimulation (DBS) is another surgical option when severe essential tremor does not respond to medication. In this procedure, a hair-thin wire is implanted in the thalamus and connected to a device (called a neurostimulator) that is implanted under the collarbone. The neurostimulator sends electrical impulses along the wire to the thalamus to interrupt signals that cause tremor.
Patients can turn DBS on when needed and turn it off when tremors are infrequent (e.g., during sleep). Studies have shown that DBS reduces essential tremor and improves patients' ability to perform daily activities.
In June 2015, the U.S. Food and Drug Administration (FDA) approved the Brio Neurostimulation System to reduce symptoms of essential tremor. This device consists of a small battery-powered, rechargeable pulse generator that is implanted under the skin in the upper chest and wire leads that connect to electrodes in certain areas of the brain. Research shows the System can control symptoms without the need for medications. Adverse effects include infection, dislocation of the device lead, and intracranial bleeding, which can cause stroke.
Updated by Remedy Health Media