Treatment of Essential Tremor with Stereotactic

RadiosurgeryPresenter: Christopher

Loiselle, MDPoster # 1024

Treatment of Essential Tremor with Stereotactic

Radiosurgery• Essential tremor– Very common (5% population > age 65)– Primarily an action tremor– 95% of the time affects hands– Can be disabling leading to basic activities

such as writing, drinking, eating, cooking, using utensils, brushing teeth, holding a tray.

– Familial in 60%– Pathophysiologic recordings of VIM

thalamus demonstrate neurons that dischage excessively and synchronously

Treatment of Essential Tremor with Stereotactic

Radiosurgery• Essential tremor– Treatment options: medical therapy,

deep brain stimulation, radiosurgical thalamotomy

– Radiosurgical thalamotomy is an ideal treatment for patients with medically refractory disease who are not candidates for deep brain stimulation

Treatment of Essential Tremor with Stereotactic

Radiosurgery• Current retrospective series: – 99 thalamotomies with the Gamma Knife in 94

patients– 77% of cases had major improvement in

drawing– 81% of cases had major improvement in writing– 7 patients developed side effects following

treatment including contralateral numbness, contralateral weakness, or speech difficulty. One patient’s side effects resolved during the followup period.

Treatment of Essential Tremor with Stereotactic

Radiosurgery• For patients with a positive

result (about 80%), the benefits of treatment are a remarkable improvement in life quality

• The future:– Prospective studies– Development of patient selection tools

and/or treatment techniques to further minimize potential side effects.