Feasibility of Staged Bilateral Radiofrequency Ventral Intermediate Nucleus Thalamotomy for Bilateral Essential Tremor.

Abstract

Patients with bilateral and/or midline/axial tremor have significant diminution in quality of life (QOL). Various studies report high complication rates with bilateral thalamotomy. However, use of primitive methods in these studies confers questionable validity. We conducted a retrospective observational cohort study in patients with medication-refractory bilateral essential tremor treated with staged bilateral radiofrequency ventral intermediate nucleus thalamotomy to subjectively examine the impact of any adverse effects on QOL and patient satisfaction. Eight patients who had undergone staged bilateral radiofrequency ventral intermediate nucleus thalamotomy were included and completed a customized questionnaire. Patients returned the completed questionnaire by mail for statistical analysis. All 8 patients had improved QOL. Seven patients were satisfied with the received treatment, although residual neck and hand tremor remained in 5 and 4 patients, respectively. None of the patients reported worsening of symptoms or severe disability in any area. Adverse effects included speech difficulty, difficulty in concentration, memory loss, and calculation difficulty. All 8 patients were self-reliant in doing everyday tasks that were not possible before the treatment suggesting the nondisabling nature of the adverse effects that occurred. Adverse effects that are nondisabling and hence acceptable to the patient can be considered acceptable adverse effects. Staged bilateral radiofrequency ventral intermediate nucleus thalamotomy definitely improves QOL in patients with medication-refractory bilateral essential tremor despite occurrence of acceptable adverse effects.