Essential Tremor Treatment Options

How Is Essential Tremor Treated?

Mild essential tremor may not require treatment. However, if essential tremor interferes with your ability to function or if you are uncomfortable in social situations, there are treatments that may improve symptoms.

Treatments may include medications (as the first line of treatment), the Neuravive treatment or surgical options.

Please keep in mind that only a physician can advise you on the risks, benefits, and alternatives for treating your condition. The general information provided below is not medical advice.

Neuravive: MR Guided Focused Ultrasound Technology
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Neuravive, MR guided Focused Ultrasound (MRgFUS), is a new technique that is now available to neurosurgeons where ultrasound waves can be focused through the skull to target the Vim of the thalamus, a very specific location deep within the brain, without the need for incisions or holes in the skull.   This is the same target used for years with other more invasive surgery, but now can be reached without incisions or anesthesia.   Thus, it is much less invasive than conventional surgery.

MR guided Focused Ultrasound (MRgFUS) is a treatment that combines two technologies – High intensity focused ultrasound that is guided by Magnetic Resonance Imaging.

The high intensity focused ultrasound (FUS) generates heat at the focal point to create a tiny lesion in the targeted area of the brain.

The MRI system is the eyes of the treatment, enabling the physician to identify and target the treated area with high precision as well as monitor the temperature during treatment.

Risks associated with any thalamotomy, including Neuravive, include transient and/or permanent sensory numbness, imbalance, and/or gait disturbance. These events are generally transient and mild or moderate in severity. Other risks and adverse events associated with the treatment include brief sonication-related pain, brief sonication-related dizziness,  nausea and potential for deep vein thrombosis associated with lengthy time on the treatment bed.

Neuravive may be a treatment option for patients with medication-refractory essential tremor who are at least 22 years old.

For additional information on Neuravive, CLICK HERE.

For additional safety information on Neuravive CLICK HERE.

Deep Brain Stimulation (DBS) Surgery
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Today, the most common approach to treating essential tremor when medications no longer help is deep brain stimulation (DBS). This form of treatment consists of staged surgeries to implant an electrode deep into the brain, tunnel the wires under the skin down the neck and implant a pulse generator below the skin near the collar bone.   This treatment targets the same location as the Neuravive MRgFUS treatment.   DBS requires follow up throughout the patient’s life for adjustment of stimulation and eventual replacement of generator(s) to replace batteries.  As an invasive surgery to access the brain, DBS poses inherent risks such as infection and bleeding in the brain as does the implantation of chronic hardware in the body.

Medication
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There are no medications specifically designed to treat essential tremor, but there are some medications which can reduce the severity of the tremor in some patients:

  • Propranolol (Inderal®)is the only medication approved by the FDA for the treatment of essential tremor, but it is primarily used for treating high blood pressure
  • Primidone (Mysoline®) is an anti-seizure medicine
  • Anti-anxiety medications may be useful in patients who do not respond to other medications or who have associated anxiety

These medications can cause side effects, and you should ask your physician to learn more.

Stereotactic Radiosurgery
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Stereotactic radiosurgery emits highly accurate gamma radiation beams to target the cells of the ventral intermediate nucleus (VIM) in the thalamus in order to destroy overactive cells that cause tremor. Surrounding areas remain untouched as beams of focused radiation are deployed. There is a chance radiation will spread to other parts of the brain and cause side effects due to inadvertent death of healthy tissue, and there is potential for unknown and potentially permanent side effects because it is difficult to accurately localize radiation dosage.

Thalamotomy
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Conventional, surgical thalamotomy is an invasive procedure where the target ( the Vim of the thalamus) is surgically destroyed (ablated). Neurosurgeons use specialized probes inserted deep into the brain to precisely locate the treatment target.  Like DBS surgery and the Neuravive procedure, the patient is usually awake, and the area on the scalp where the surgical tools are inserted is numbed with an anesthetic.  Different methods can be used to kill the brain cells, including radio-frequency heating or cooling with a special probe. As an invasive surgery to access the brain, thalamotomies pose inherent risks, such as infection and bleeding in the brain.

Additional information about these treatment options is available at https://www.essentialtremor.org/treatments/ and https://www.webmd.com/brain/essential-tremor-stereotactic-thalamotomy.

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