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.

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 sound waves can be focused through the skull to target 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 proven 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.

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 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®) – 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
Stereotactic Radiosurgery
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Stereotactic radiosurgery emits powerful, 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 192 beams of focused radiation are combined with a low dose of radiation.

Thalamotomy
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Conventional, surgical thalamotomy is an invasive procedure where the target in the thalamus (Vim) 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, however, 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.