Journal of the Korean Society of Stereotactic and Functional Neurosurgery 2005;1(2):179-182.
Published online September 30, 2005.
Surgical Treatments for Secondary Tremor
Kyu-Yeul Ji, Ryoong Huh, Jung-Yong Ahn, Young-Sun Chung, Tae-Gon Kim, Sang-Sup Chung
Department of Neurosurgery, Bundang CHA Hospital, Pochon CHA Medical University, Seongnam, Korea
The surgical treatments, such as ventralios intermedius nucleus (Vim) thalamotomy and thalamic deep brain stimulation (DBS) for essential tremor have already been established as being an effective and safe method. However, such effectiveness for secondary tremor has not yet been established. The authors of this study have performed several cases of surgical treatments for the treatment of secondary tremor and we hereby describe the operative results. Method: Eight surgical procedures in 6 patients who had undergone the surgical treatments for secondary tremor from October 1997 to February 2005, were analyzed. The sex ratio was 2 : 1 (male : female) and mean age was 44.1 ± 17.6 years. The mean symptom duration was 12.4 ± 4.5 months and postoperative follow-up duration was 13.5 ± 6.3 months. There were 3 Holmes' tremor patients, 2 post-stroke tremor and 1 post-traumatic tremor. We performed preoperative and postoperative radiological studies, activity of daily living (ADL) evaluations and psychiatric evaluations in all cases.
We performed 6 Vim thalamotomies and 2 thalamic DBS. The surgical results were divided into four groups labeled "excellent," "good," "fair," and "poor". There were 2 "excellent" results which showed no detectable tremor (2 post-traumatic tremor), 3 "good" group patients showed slight residual tremor without medication (2 post-stroke tremor and 1 Holmes- tremor) and much improved in ADL, 3 "fair" result with appreciable residual tremor (2 Holmes' tremor and 1 post-stroke tremor) but improved in ADL. There was no significant surgical complications.
The surgical treatments for secondary tremor improved ADL. Holmes' tremor cases tended poorer results than other types of secondary tremor. More active treatment, such as Vim thalamotomy and thalamic DBS for secondary tremor is recommended.
Key Words: Secondary tremor, Holmes’ tremor, Ventralis intermedius nucleus thalmotomy, Thalmic deep brain stimulation.
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