Essential Tremor
What is essential tremor?
Essential tremor is the most common movement disorder affecting an estimated 3% of the population. Essential tremor causes involuntary shaking, most often in the hands, but can also impact the head and voice. These symptoms can negatively impact a patient's quality of life. Many patients can manage their symptoms with medication, but when medication becomes ineffective, the managing neurologist may recommend a surgical evaluation to determine if the patient is a candidate for surgery.
Patients considering surgery undergo a careful evaluation with the CU Anschutz Advanced Therapies for Movement Disorders (ATMD) team. During the evaluation, the patients diagnosis and previous treatments are reviewed by an expert in the field. After evaluation, all reasonable treatment options, including medications, continuous infusions, and surgical options, are discussed with the patient. The team tailors the treatment to meet the goals of the patient.
UCHealth's Movement Disorders Center is the largest provider of comprehensive neurological and neurosurgical care in the Rocky Mountain region. Our team has distinguished experience in determining the cause of tremors and works collaboratively to provide the appropriate treatment and best care for each individual patient.
Deep brain stimulation for essential tremor
Deep brain stimulation (DBS) is an advanced treatment available for essential tremor, Parkinson's disease, and dystonia. DBS is a type of brain surgery that uses electrical implants to improve control of movement by blocking the abnormal activity of neurons that cause debilitating neurological problems. While it is not a cure, DBS can restore a patient's quality of life and help patients get back to doing things that were made difficult by their tremor.
During DBS surgery, thin wires with attached electrodes are implanted into specific areas of the brain. Based on the disorder and symptoms, our highly-trained, multidisciplinary team determines the precise location of where to place the electrodes. The wires are then connected to a small pulse generator (neurostimulator) placed under the skin of the chest near your collarbone. A few weeks after everything has been implanted, the neurostimulator is programmed and adjusted to best control your symptoms.
DBS therapy for essential tremor can significantly reduce tremor. Essential tremor patients may qualify for DBS therapy if they meet the following criteria:
- Patient has undergone trials of multiple medications that proved to be ineffective
- Patient suffers from tremor that is disabling
- Patient is in reasonably good health
Success of the DBS procedure is highly dependent on the surgical team's ability to effectively place and program the electrode stimulators. UCHealth's Movement Disorders Center is currently one of the largest academic and research DBS surgery centers in the Rocky Mountain region.
Focused ultrasound for essential tremor
High-intensity focused ultrasound (HIFU) is an incisionless therapeutic technology used to identify, target, and treat the precise area in the brain responsible for the tremor. Guided by MRI, ultrasound waves are used to treat deep structures in the brain that are responsible for the tremor. The temperature at the target rises high enough to create a small ablation or burn. This provides a therapeutic effect.
Patients who have been diagnosed with essential tremor or tremor-dominant Parkinson's disease who do not receive tremor relief from medications many benefit from a focused ultrasound consultation.
Focused ultrasound for essential tremor is an outpatient procedure, and patients typically go home on the same day. The results are immediate and there is no upper age limit for the procedure. Patients that do not meet the criteria for DBS may be candidates for HIFU.
HIFU for essential tremor has been approved in Colorado for staged unilateral treatment, treating both sides of the brain with a minimum of nine months between treatments.
Patients may be a candidate for focused ultrasound for essential tremor if they meet the following criteria:
- Patient has tried and failed to respond adequately to primidone and propranolol
- Patient is under 300 pounds and is able to go into an MRI and has no metallic implants
- Patient is otherwise healthy and can lie still in the same position for up to three hour
In addition to the above criteria, patients will undergo a complete head shave before the procedure.
Learn more about focused ultrasound for essential tremor during an upcoming patient webinar led by Drew Kern, MD.