Relief of intention tremor by thalamic surgery.

Abstract

In 1960, it was first reported by one of us (Cooper, 1960a) that intention tremor could be relieved by a surgical lesion placed in the ventrolateral nucleus of the thalamus. Since then, a number of reports have appeared in the literature (Cooper, 1960b;Broager and Fog, 1962; Cooper, 1962b;Krayenbuhl and Yasargil, 1962; Cooper, 1965;Laitinen, 1965;Fox and Kurtzke, 1966), corroborating the therapeutic value of thalamic surgery for intention tremor.It is the purpose of this report to summarize our results and sequelae of cryothalamectomy, carried out on 73 consecutive cases of intention tremor of diverse aetiology. These operations were performed during the period of 10 August 1966 until 26 July 1968. MATERIAL AND METHODSThe seventy-three patients were examined pre-operatively by the investigative team on the neurosurgical service at St. Barnabas Hospital. In the clinical analysis of the symptoms, intention tremor was rated on a five-point scale, ranging from 0 for absence of the tremor to +4 for maximum rating. Pre-and post-operative motion pictures were obtained in each case. In addition, a special objective method (Dierssen, Lorenc, and Spitaleri, 1961) of evaluation of individual motion picture frames before and after surgery, provided a measurable index of intention tremor (Fig. 1).Language and speech assessments were made one to three days before surgery, within two weeks after surgery, and in some cases during follow-up re-evaluation of varying periods.Pre-operative psychological data on each patient were derived from clinical interviews conducted by an experienced psychologist. On the basis of these initial interviews each patient was rated on a three-point scale as a good, fair, or poor candidate for surgery. Usually, patients with 'poor' pre-operative psychological ratings did not, and do not, undergo surgery. However, since the decision regarding advisability of surgery must take into account medical condition, neurological factors, and other variables, in addition to psychological findings, some patients with a 'poor' psychological rating may ' The causes of intention tremor in the present series were as follows: familial (26 cases); multiple sclerosis (25 cases); cerebellar degeneration of unknown origin (seven cases); post-traumatic (five cases); posterior fossa tumour (one case); Leber's disease (one case); and associated with torticollis in two cases and Parkinsonism in six cases. Thirty-nine patients were males and 34 were females. There was male preponderance in the familial group in contrast with the multiple sclerosis cases. The age incidence varied from 15 to 79 years with a mean of 42-3 years. All the patients, except one, were right handed. The average duration of the tremor was 17-9 years with a range of two to 50 years. The tremor was unilateral in three cases and bilateral in the remaining. The upper extremities were affected more than the lower; and the right side slightly more than the left. In 13 patients, there was neck tremor in addition to limb tremor. In all cases, the tremor was se...

A Comparison of Continuous Thalamic Stimulation and Thalamotomy for Suppression of Severe Tremor

“…[1][2][3][4][5][6] Thalamic stimulation was effective in 70 percent of patients with multiple sclerosis in two small series, 19,23 but the preliminary results of a prospective evaluation were less favorable. 38 Thalamotomy has been reported to result in long-term suppression of tremor in 30 percent 39 to 80 percent 40 of patients with multiple sclerosis, and this wide range probably relates to the varied origins of tremor, which depend on the location of the sclerotic lesions. 17 In our study, the response to surgery of patients with multiple sclerosis was not as good as that of patients with Parkinson's disease or essential tremor.…”

Thalamotomy versus thalamic stimulation for multiple sclerosis tremor

“…1,2,[16][17][18] Particularly disabling is a kinetic tremor involving the arm. This action tremor appears during movement and is frequently exacerbated by intention.…”

Post-deep brain stimulation — gradual non-stimulation dependent decrease in strength with attenuation of multiple sclerosis tremor

“…However, in some MS patients the tremor can be resistant to surgical therapy [1,3,4,15,18,21]. Surgical strategies to treat MS tremor have traditionally targeted the ventral intermediate (VIM) and/or the ventral oralis posterior (VOP) nuclei of the thalamus contralateral to the affected limb, either by thalamotomy or by deep brain stimulation [8,9,15,18,21].…”