Multicentre European study of thalamic stimulation in parkinsonian and essential tremor

OBJECTIVES: Thalamic stimulation has been proposed to treat disabling tremor. The aims of this multicentre study were to evaluate the efficacy and the morbidity of thalamic stimulation in a large number of patients with parkinsonian or essential tremor. METHODS: One hundred and eleven patients were included in the study and 110 were implanted either unilaterally or bilaterally. Patients were evaluated with clinical scales, before and up to 12 months after surgery. RESULTS: Upper and lower limb tremor scores were reduced in both groups. Eighty five per cent of the electrodes satisfied the arbitrary criteria of two point reduction in rest tremor reduction in the parkinsonian tremor group and 89% for postural tremor reduction in the essential tremor group. In the parkinsonian tremor group, limb akinesia and limb rigidity scores were moderately but significantly reduced. Axial scores were unchanged. In the essential tremor group, head tremor was significantly reduced only at 3 months and voice tremor was non-significantly reduced. Activities of daily living were improved in both groups. Changes in medication were moderate. Adverse effects related to the surgery were mild and reversible. CONCLUSIONS: Thalamic stimulation was shown to be an effective and relatively safe treatment for disabling tremor. This procedure initially applied in a very limited number of centres has been successfully used in 13 participating centres.