Efficacy and safety of stereotaxic surgical treatment of tremor disorders

Limitations of current pharmacologic therapies and advances in surgical techniques have led to renewed interest in the stereotaxic treatment of tremor disorders. Thalamotomy is an effective treatment for parkinsonian tremor. Long-term efficacy is established Persistent morbidity with unilateral operations is rare, consisting of dysarthria, dysphagia and paresis. Bilateral thalamotomies are associated with a high prevalence of speech impairment. Thalamotomies are also effective for essential and post-traumatic tremors. Thalamotomies have a limited role in the cerebellar tremors of multiple sclerosis as functional disabilities cannot be reversed. Pallidotomy and pallidal stimulation may have a role in the treatment of Parkinson's disease; however, its effect on tremor has not been defined. Thalamic stimulation is effective for parkinsonism and essential tremor. We favour this procedure because of its reversibility and adaptability.