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Tsinsue Chen, Zaman Mirzadeh, Kristina Chapple, Margaret Lambert, Rohit Dhall, and Francisco A. Ponce

D eep brain stimulation (DBS) is typically performed with intraoperative test stimulation in awake patients. For patients with essential tremor, the target is often the ventral intermediate nucleus (VIM). Indirect targeting is achieved by placing leads at consensus coordinates based on stereotactic anatomical atlases, and repositioning as needed based on electrophysiological mapping and/or test stimulation with the latter determining clinical benefit and side-effect profile. 26 , 21 , 30 There is growing interest in performing DBS on patients with

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Douglas Kondziolka, Joseph G. Ong, John Y. K. Lee, Robert Y. Moore, John C. Flickinger, and L. Dade Lunsford

E ssential tremor is the most common adult movement disorder. 9 The hallmark of essential tremor is a progressive kinetic tremor of the arms. 8 Those patients who seek medical attention are often forced to change employment or retire early, since symptoms are progressively disabling and lead to a significant loss of independence. For patients with severe essential tremor refractory to medical therapy, surgery is a viable option. Two alternative procedures for the treatment of disabling tremor include stereotactic radiofrequency thalamotomy and high

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John Y. K. Lee and Douglas Kondziolka

); electrode migration (8 mm deep), which required surgery to pull back the lead (one patient); and mild hand tingling during stimulation (three patients). Twelve of 18 patients with implanted systems had no morbid condition. Discussion Essential tremor is the most common movement disorder. 20 It is characterized by bilateral action tremor of the hands and forearms, the head, and, less commonly, the voice, in the absence of other neurological signs. 2 The vast majority of patients with ET suffer from mild tremor, which can be treated with various medications

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Puneet Plaha, Nikunj K. Patel, and Steven S. Gill

E ssential tremor is a common movement disorder that occurs in 300 to 415 persons per 100,000 population. 6 The incidence of new cases increases with the age of the person and the disorder is known to affect both men and women equally. Essential tremor has an autosomal-dominant inheritance with variable clinical expression and almost complete penetrance by the age of 65 years. 1, 22 The cause of ET is poorly understood. Although no morphological changes have been identified, 31 it has been attributed to a functional disturbance in the inferior olivary

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Alan Diamond, Christopher Kenney, Michael Almaguer, and Joseph Jankovic

nuclei involved in autonomic control . Prog Brain Res 87 : 253 – 268 , 1991 10 Louis ED : Essential tremor . Lancet Neurol 4 : 100 – 110 , 2005 11 Murata J , Kitagawa M , Uesugi H , Saito H , Iwasaki Y , Kikuchi S , : Electrical stimulation of the posterior subthalamic area for the treatment of intractable proximal tremor . J Neurosurg 99 : 708 – 715 , 2003 12 Ondo W , Jankovic J , Schwartz K , Almaguer M , Simpson RK : Unilateral thalamic deep brain stimulation for refractory essential tremor and Parkinson

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Ronald F. Young, Francisco Li, Sandra Vermeulen, and Robert Meier

E ssential tremor is probably the most common movement disorder recognized in the population, with a frequency of ~ 300–400 cases per 100,000 population. 6 Although ET is often referred to as benign, it is anything but benign for those who suffer from it. 24 It is primarily an action tremor, and may not be apparent to physicians unless they test specifically for it, whereas the tremor of Parkinson disease is mainly a rest tremor and is obvious on simple inspection of the patient. Essential tremor tends to be present mainly in the dominant hand, but

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Julie G. Pilitsis, Leo Verhagen Metman, John R. Toleikis, Lindsay E. Hughes, Sepehr B. Sani, and Roy A. E. Bakay

D eep brain stimulation was first introduced for the treatment of essential tremor in 1991. 3 Over the past decade, a number of studies have been published confirming the safety and efficacy of stimulation of the thalamic VIM for the treatment of essential tremor in long-term (1–6-year) follow-up. 26 , 28 , 32 However, some series have reported that 13–40% of these patients may become refractory to treatment over time. 3 , 10 , 16 Review of the literature suggests that there are 2 groups of patients with stimulation failure—those who lose benefit in the

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Jules M. Nazzaro, Rajesh Pahwa, and Kelly E. Lyons

. The only change made to the PDQ-39 for this study was the replacement of the words “Parkinson disease” with the words “essential tremor.” 6 The PDQ-39 has subscale scores representing mobility (10 questions), ADL (6 questions), emotional well-being (6 questions), stigma (4 questions), social support (3 questions), cognition (4 questions), communication (3 questions), and bodily discomfort (3 questions). Scores are represented as percentages, with 0% being the best QOL and 100% being the worst. Patients were also evaluated with the Fahn-Tolosa-Marin TRS 5 at

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Alon Sinai, Maria Nassar, Ayelet Eran, Marius Constantinescu, Menashe Zaaroor, Elliot Sprecher, and Ilana Schlesinger

U nilateral MR-guided focused ultrasound (MRgFUS) ventral intermediate nucleus (VIM) thalamotomy for treatment of medically refractory and debilitating tremor has been CE approved since 2013 and was FDA approved for treatment of essential tremor (ET) in July 2016. The treatment involves multiple sonications, starting with low-energy sonications with gradual raising of the temperature until a therapeutic response is observed without undesired side effects. 16 Such treatments performed multiple times will eventually sculpt the final lesion in the contralateral

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Arjun S. Chandran, Stuti Joshi, Megan Thorburn, Rick Stell, and Christopher R. P. Lind

T he posterior subthalamic area (PSA) is a promising alternative target in the thalamus for neurosurgeons performing deep brain stimulation (DBS) for both Parkinson's disease and essential tremor (ET). 6 , 12 , 16 , 18 The structures composing the PSA include the zona incerta, posterodorsal part of the subthalamic nucleus, and pallidothalamic (fields of Forel) and cerebellothalamic (prelemniscal) fiber tracts. 5 , 27 Targeting the PSA in treatments for movement disorders has been advocated largely because of positive results of subthalamotomy performed