Comparisons of Radiofrequency Thalamotomy and Deep Brain Stimulation for Parkinsonian Tremor Patients

Ha, Bok Young; Park, Eun Suk; Kwon, Soon Chan; Lyo, In Uk; Sim, Hong Bo; Kim, Moo Seong

Original article

Journal of the Korean Society of Stereotactic and Functional Neurosurgery 2012;8(2):104-107.
Published online September 30, 2012.

Comparisons of Radiofrequency Thalamotomy and Deep Brain Stimulation for Parkinsonian Tremor Patients

Bok Young Ha, Eun Suk Park, Soon Chan Kwon, In Uk Lyo, Hong Bo Sim, Moo Seong Kim

Department of Neurosurgery, Ulsan University Hospital, Ulsan University, College of Medicine, Ulsan, KoreaDepartment of Neurosurgery, Busan Paik Hospital, Inje University, College of Medicine, Busan, Korea

Abstract

Objective
Tremor, either essential tremor or Parkinsonian tremor, have been effectively and safely treated by radiofrequency (RF) lesioning or Deep brain stimulation (DBS). The primary target is the ventral intermediate (Vim) nucleus of the thalamus, with or without microelectrode recording.
Methods
Between September, 2001, and December, 2011, 21 consecutive tremor patients treated with RF thalamotomy without microelectrode recording and DBS. Among them, 16 patients with Parkinsonian tremors were treated with RF thalamotomy without microelectrode recording. Other 5 Parkinson's tremor patients were operated with bilateral Vim-DBS. Preoperative and postoperative tremor was evaluated with simple tremor severity scale, United Parkinson's disease Rating Scale tremor score (UPDRS) and the development of complications related to the procedure was closely reviewed during the immediate postoperative period and the last follow-up.
Results
RF thalamotomy produces immediate relief in up to 98.4% of patients. There was no development of complications related to the procedure ; all patients were discharged one or two days later following surgery. In DBS surgery patients, tremor was completely abolished in 40% of patients, and almost abolished in 60%. There were no complications.
Conclusions
Vim RF thalamotomy without microelectrode recording is a safe and effective procedure to control tremors with minimal morbidity. DBS is also very beneficial in treating bilateral intractable tremor patients. Intraoperative macroelectrode stimulation safely localizes the Vim nucleus target of the thalamus for treatment of patients with tremors.

Key Words: Tremor, Thalamotomy, Deep brain stimulation.