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Neurology (Expert Forum)
Re: Essential Tremor
This forum is for questions and support regarding neurology issues such as: Alzheimer's Disease, ALS, Autism, Brain Cancer, Cerebral Palsy, Chronic Pain, Epilepsy, Fibromyalgia, Headaches, MS, Neuralgia, Neuropathy, Parkinson's Disease, RSD, Sleep Disorders, Stroke, Traumatic Brain Injury.
Re: Essential Tremor
by CCF MD mdf, Jan 01, 1995 12:00AM
Posted By CCF MD mdf on August 13, 1998 at 14:27:19:
In Reply to: Essential Tremor posted by Shelley on August 11, 1998 at 15:05:11:
My father suffers from tremors that were diagnosed as Essential (Familial) tremors. His mother also suffered from this. He is 61 years old and now can barely prepare a meal. He ended up turning to alcohol because it decreased the tremors and is now in rehab. I was wondering what the surgeries involved and what this Deep Brain Stimulation was all about. He has taken various drugs (Propanolol, Primidone and I think Clonazepam) none of which helped enough. His condition is now quite severe. If surgery might help I would like more info so he won't go back to the alcohol to help the shakes. Please let me know whatever you can on other possibilities and whether the medication in conjunction with the alcohol may have been the reason the medication didn't work.
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Deep Brain Stimulation [Activa (TM)] is a reasonable option for patients with tremor who meet the following criteria:
- limb tremor (not effective for head or voice tremor)
- significant impact on activities (not justified for trivial tremor)
- failure of best medical therapy (propranolol, clonazepam, mysoline, etc)
- no major medical reasons to avoid surgery
- no major cognitive impairment (eg dementia)
Briefly, an electrode is implanted in a specific target region of the brain, connected to a pacemaker, and the electrode emits stimulating pulses at a certain frequency and intensity (programmable). This stimulation keeps that area of the brain "stunned" and turns off tremor in the arm/hand on the opposite side of the body. It is an improvement on an older technique of actually making a permanent lesion ("cooking") in the same target brain region. Although potentially more technically complex, the rewards are better fine tuning afterward and lower risk of complications from missed target site, lesion too large, etc.
Obviously, where your dad fits in this scheme depends on a careful evaluation by an experienced practitioner and thorough discussion of all the options. Some patients are "perfect" for surgery, except they want to have nothing to do with it. Others are psychologically "ready" for the procedure but are not a good risk from the other factors. How much tremor is "trivial" versus "disabling" is a judgment call, very individual.
I would recommend a specific person here at Cleveland Clinic. That is Dr Erwin Montgomery, who is a movement disorders specialist (neurologist) who sees more tremor than anyone else. He works very closely with the neurosurgeon (Dr Gene Barnett) and participates in the implantation of each Activa (TM) system. He is the local CCF expert on pre-surgical evaluation, physiologic monitoring during the operation, and post-surgical adjustment of the "pacemaker" devices.
Call 800 223-2273, ext 4-5559, ask for neurology appointments and let them know you want to see Dr Montgomery. I hope this helps. CCF MD mdf.
In Reply to: Essential Tremor posted by Shelley on August 11, 1998 at 15:05:11:
My father suffers from tremors that were diagnosed as Essential (Familial) tremors. His mother also suffered from this. He is 61 years old and now can barely prepare a meal. He ended up turning to alcohol because it decreased the tremors and is now in rehab. I was wondering what the surgeries involved and what this Deep Brain Stimulation was all about. He has taken various drugs (Propanolol, Primidone and I think Clonazepam) none of which helped enough. His condition is now quite severe. If surgery might help I would like more info so he won't go back to the alcohol to help the shakes. Please let me know whatever you can on other possibilities and whether the medication in conjunction with the alcohol may have been the reason the medication didn't work.
=
Deep Brain Stimulation [Activa (TM)] is a reasonable option for patients with tremor who meet the following criteria:
- limb tremor (not effective for head or voice tremor)
- significant impact on activities (not justified for trivial tremor)
- failure of best medical therapy (propranolol, clonazepam, mysoline, etc)
- no major medical reasons to avoid surgery
- no major cognitive impairment (eg dementia)
Briefly, an electrode is implanted in a specific target region of the brain, connected to a pacemaker, and the electrode emits stimulating pulses at a certain frequency and intensity (programmable). This stimulation keeps that area of the brain "stunned" and turns off tremor in the arm/hand on the opposite side of the body. It is an improvement on an older technique of actually making a permanent lesion ("cooking") in the same target brain region. Although potentially more technically complex, the rewards are better fine tuning afterward and lower risk of complications from missed target site, lesion too large, etc.
Obviously, where your dad fits in this scheme depends on a careful evaluation by an experienced practitioner and thorough discussion of all the options. Some patients are "perfect" for surgery, except they want to have nothing to do with it. Others are psychologically "ready" for the procedure but are not a good risk from the other factors. How much tremor is "trivial" versus "disabling" is a judgment call, very individual.
I would recommend a specific person here at Cleveland Clinic. That is Dr Erwin Montgomery, who is a movement disorders specialist (neurologist) who sees more tremor than anyone else. He works very closely with the neurosurgeon (Dr Gene Barnett) and participates in the implantation of each Activa (TM) system. He is the local CCF expert on pre-surgical evaluation, physiologic monitoring during the operation, and post-surgical adjustment of the "pacemaker" devices.
Call 800 223-2273, ext 4-5559, ask for neurology appointments and let them know you want to see Dr Montgomery. I hope this helps. CCF MD mdf.
