DBS for Essential Tremor

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Deep Brain Stimulation for Essential Tremor


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What is essential tremor?   

What are the symptoms of essential tremor?   

What causes essential tremor?   

How is essential tremor diagnosed?   

How can deep brain stimulation help treat essential tremor?   

What are the risks of DBS surgery for essential tremor?   

What are the potential side effects of DBS surgery for essential tremor?   

How can the surgery or side effects be reversed?   

What can I expect my results to be like?   

Where can I find more information?   

 

What is essential tremor?

Essential tremor is a neurological disease that causes uncontrollable shaking in one or more of your upper extremities (the lower body is rarely affected). It is similar to Parkinson’s disease.

 

What are the symptoms of essential tremor?

Essential tremor causes rhythmic shaking, or tremors, most often in the hands. The symptoms of essential tremor occur gradually and get worse with time. You will notice that your symptoms get worse when you voluntarily move the affected extremity. Some factors, like stress, caffeine intake, or temperature change can make your symptoms worse.

Essential tremor causes symptoms similar to Parkinson’s disease. However, differences in three key areas can help you and your doctor distinguish between the two conditions:

  • Where you notice symptoms—Essential tremor can affect the head, hands, or voice. Parkinson’s disease typically does not affect the head or the voice.

  • What symptoms you notice—Parkinson’s disease usually causes symptoms like a shuffling walk and poor or stooped posture. Symptoms of essential tremor typically are confined to the part or parts of your body that are affected and do not affect gait or posture.

  • When you notice symptoms—Essential tremor symptoms get worse with voluntary movement. Parkinsonian tremors are most intense when you are resting.

 

What causes essential tremor?

Although, genes from your parents may be a cause of essential tremor, this mechanism only accounts for about half of essential tremor patients. The cause in other patients is unknown. However, the thalamus, a structure deep within your brain, is thought to be involved.

 

How is essential tremor diagnosed?

Your doctor will ask you about your medical history and may order imaging tests to rule out other conditions. Unfortunately, there is no simple, definitive method (such as a blood test) for diagnosing essential tremor.

 

How can deep brain stimulation help treat essential tremor?

The deep brain stimulation (DBS) device delivers a small electrical stimulus to an area of your brain. Once the device is turned on, your symptoms may diminish or cease altogether. In some cases, the symptoms in one part of your body may respond better than those in other parts.

Deep brain stimulation will not cure your essential tremor. Your symptoms will get worse or return if your neurostimulator device is turned off.

Three pieces of surgically implanted hardware are used in DBS treatment:

  • The lead is the part of the device that is implanted in your brain. It is made up of four insulated wires that transition into four exposed electrodes at the tip of the stimulator.

  • The extension is a small wire that connects to the lead outside your brain and passes under your skin from your head and down your neck. It ends in your upper chest at the site of the neurostimulator.

  • The neurostimulator is a pacemaker-like device that contains the power source for the lead and other electronics. Your surgeon will implant the neurostimulator in your upper chest, below your collarbone. The neurostimulator is attached to the extension, which carries power to the lead, where targeted amounts of electrical power are delivered to the affected area of your brain.

Your doctor will be able to adjust the neurostimulator wirelessly after surgery. You will also be able to turn the device on and off by holding a magnet near the device.

What are the risks of DBS surgery for essential tremor?

Deep brain stimulation surgery carries similar risks to other invasive neurological procedures, including the following:
  • infection
  • bleeding inside the brain
  • seizures
  • coma or death
  • pain at the surgery site
  • headache
  • cognitive problems

 

What are the potential side effects of DBS surgery for essential tremor?

Once your device is installed and turned on, you may experience the following side effects:
  • dizziness or lightheadedness (disequilibrium)
  • vision problems (double vision)
  • numbness (hypoesthesia)
  • temporary worsening of symptoms
  • facial and limb muscle weakness or partial paralysis (paresis)
  • speech problems like whispering (dysarthria) and trouble forming words (dysphasia)
  • déjà vu (this can be corrected by surgical repositioning of the lead)
  • tingling sensation (paresthesia)
  • persistent cough with stimulation on
  • abnormal, involuntary movements (chorea, dystonia, dyskinesia)
  • movement problems or reduced coordination
  • jolting or shocking sensation

 

How can the surgery or side effects be reversed?

If the severity of your side effects outweighs the benefits of the treatment, the device can be turned off or adjusted. Your neurostimulator can be removed if necessary.

 

What can I expect my results to be like?

Results will vary for each patient. After 12 months of observation, most patients report improved quality of life and are able to perform daily actions (like tying shoes or brushing teeth) that were impossible before deep brain stimulation treatment for their essential tremor.

 

Where can I find more information?

International Essential Tremor Foundation

Medtronic DBS for Essential Tremor

Medscape: Essential Tremor

Medline Plus: Deep Brain Stimulation

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Barrow Neurological Institute
350 W. Thomas Road
Phoenix, AZ 85013
(602) 406-3000