Thalamotomy For Essential Tremor Explained
Essential tremor (ET) is a neurological disorder that affects the cerebellum, the part of the brain that controls movement. While it is still unclear why, ET causes a miscommunication between the cerebellum and another part of the body, such as the hands or head, resulting in involuntary rhythmic shaking or trembling. Although the body part most often on the receiving end of this miscue is the hand, the legs, head, and torso can also be affected. Some individuals with ET also experience voice abnormalities.
Although essential tremor is the most common movement disorder in the United States, it is often confused with Parkinson’s disease which is also characterized by involuntary shaking. Ironically, ten times as many Americans have essential tremor disorder than Parkinson’s Disease, according to University of Michigan Health.
However, there are significant differences between essential tremor and Parkinson’s disease. In the case of essential tremor, the shaking is known as an action tremor or a postural tremor since it is most often observed when the muscles are engaged as when the individual extends an arm or picks up an object. When the limb is at rest, tremors either cease altogether or become barely noticeable. In the case of Parkinson’s disease, it’s typically the opposite. Tremors are strongest when the limb is relaxed but decrease when it is in use.
Another characteristic that differentiates the two is how the symptoms progress over time. For essential tremor patients, the frequency (repetitions per second) of the tremors tends to decrease but their amplitude (strength) increases. However, there are no other symptoms. On the other hand, people who have Parkinson’s disease often suffer additional symptoms. These may include poor balance, stiffness or rigidity, a slowed walking pace, difficulty in swallowing, stooped posture, and memory difficulty. However, the two do share one commonality: while both are treatable, neither is curable. Medical and behavioral interventions can improve life quality, as can various medications, but they are usually stopgap measures.
When treatments are no longer ameliorating their symptoms and medications have stopped working, another option is available – surgery. The two most common procedures for either condition are deep brain stimulation and thalamotomy. In this post, we’ll discuss thalamotomy in detail, who it’s designed for, the associated risks, and alternative treatments.
What Is A Thalamotomy?
A thalamotomy is a procedure in which small surgical lesions are formed in the thalamus, the area of the brain that communicates with the cerebellar cortex, which controls movement in the body. A thalamotomy is a unilateral surgery which means it is performed on one side of the brain in an effort to treat the tremors occurring on the opposite side of the body.
While a thalamotomy can be used to help treat tremors, the surgery does not address slow movement, stiffness, speech issues, or difficulty walking. The procedure is in-patient and most patients will need to stay in the hospital for at least two days with a complete recovery totaling about six weeks, depending on a variety of factors.
Thalamotomy is not very common and is generally used to treat persistent tremors that severely affect one side of the body after medication is deemed insufficient. Of course, there are several risks associated with the procedure and individuals should discuss the pros and cons with their doctor before moving forward with surgery.
Who Should Undergo A Thalamotomy?
Individuals who have tried other methods of dealing with their essential tremor or Parkinson’s symptoms but are getting diminishing results may turn to a thalamotomy. They may be finding that what they once regarded as a manageable disorder has become a disability to the point that it is nearly impossible to drink from a glass, eat with utensils, or fasten buttons. Such individuals may elect to undergo a thalamotomy procedure, but it is generally regarded as a last resource.
What Are The Risks Of Undergoing A Thalamotomy For Essential Tremor
The thalamotomy procedure gets its name from the thalamus, the part of the brain that the procedure affects when surgical lesions are created by using an electrical wire, thereby interrupting abnormal wave patterns.
Unfortunately, the destructive nature of the procedure limits the individual’s future options. It also may result in serious side effects including:
- Confusion and cognitive impairment
- Difficulty speaking; loss of ability to speak
- Weakness and balance problems
Considering these excessive risks, many healthcare professionals would recommend that individuals affected by essential tremor or Parkinson’s disease try alternative therapies before undergoing thalamotomy.
How Effective Is A Thalamotomy?
According to the Washington University School of Medicine in St Louis, thalamotomy is proven to be 90% effective in controlling tremors initially, and 80% effective for long-term relief for individuals with Parkinson’s disease as well as those affected by essential tremor.
However, the procedure comes with the possibility of serious side effects and lasting consequences. Therefore, before taking any steps in this direction individuals should first research all of the Parkinson’s and essential tremor treatments available to them.
It should also be noted that the procedure is not nearly as effective in treating intention tremors or those that result from strokes, multiple sclerosis, and traumatic brain injuries. The National Center for Biological Information (NCIB) defines an intention tremor as being a type that is oscillatory, rhythmic, and of high amplitude. They are called intention tremors because they occur when a person attempts a purposefully directed motor movement. Another distinction between them and essential and Parkinson tremors is that intention tremors become stronger as the movement approaches its intended object or intended goal.
Although an intention tremor patient may see a small amount of relief from undergoing a thalamotomy, given the risk and complications, they should really assess the pros and cons of the operation with their physician. Of course, this same sentiment goes for individuals looking for Parkinson’s or essential tremor treatment.
Are There Alternatives To A Thalamotomy?
There are several alternatives to thalamotomy, including focused ultrasound, gamma knife surgery, and deep brain stimulation.
- Focused ultrasound. Similar to thalamotomy, focused ultrasound uses concentrated ultrasound waves – instead of radiation – under the guidance of MRI to burn away the portion of the thalamus that is creating abnormal brain waves.
- Gamma knife surgery. Uses radiation to target and eliminate the cells responsible for the tremors.
- Deep brain stimulation. This invasive procedure involves implanting an electrode in the brain to deliver electric impulses that block abnormal brain waves in specific areas that play a role in the tremors. A neurotransmitter is placed under the collarbone to control the impulses.
- Cala TAPS Therapy. This non-invasive essential tremor therapy has been clinically proven to help alleviate ET symptoms for an average of 94 minutes. This method employs a wristband that gently stimulates the median and radial nerves in the arm. The electrical stimulation then travels to the brain where it intercepts and interrupts abnormal tremor signals that originate in the thalamus’ nucleus.
Cala TAPS Therapy Can Help
Persistent tremors can make daily activities more difficult and degrade your confidence to live independently and do the things you love. If you’ve been diagnosed with essential tremor, Cala TAPS therapy may be a good option for you.
Unlike thalamotomy and other surgical procedures, Cala TAPS is a non-invasive therapy provided by a wrist-worn device designed to electrically stimulate the nerves that cause your tremor.
Clinical trials for Cala TAPS therapy have revealed impressive results:
- 71% of wristband wearers reported they were able to hold a cup of tea steady.
- 68% who had previously rated tremors as severe to moderate now rated them as mild.
- 64% reported 94 consecutive minutes of persistent relief.
Learn more about how our innovative essential tremor therapy can help alleviate your symptoms and help you regain your confidence today.