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Ronald R. Tasker, Ian H. Rowe, Peter Hawrylyshyn and Leslie W. Organ

Response Code 1 = pain K = cold Ai = auditory ipsilateral F = faint, light-headed, woozy 2 = Parkinson's disease W = warm Ac = auditory contralateral 3 = essential tremor H = hot TD = tremor driving 4 = multiple sclerosis B = burning Au = general auditory TR = tremor reduction 5 = cerebellar tremor Vi = vibration Oi = visual ipsilateral TA = tremor arrest 6 = dystonia P = paresthesia, tingling, numbness, electric shock Oc = visual contralateral MID = involuntary movement drive 7

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Chihiro Ohye and Hirotaro Narabayashi

structures, and serve for accurate placement of the stereotaxic lesion. Our findings are reported in this paper. Materials and Methods In this study, 37 unitary or group of unitary responses have been analyzed in 34 patients. All patients had idiopathic parkinsonism except for one who had essential tremor and another with postural tremor. As a rule, only one track was directed to the therapeutic target point, and the first sensory response encountered was analyzed. Sometimes, remote responses were obtained that could not be isolated. Such responses were discarded

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Neurosurgical Forum: Letters to the Editor To The Editor R. Sandyk , M.D. University of Arizona Tucson, Arizona 162 162 Beta-adrenergic blocking agents have for some time been recognized as efficacious in the treatment of congenital forms of action tremor as well as essential tremor. 3 In addition, these agents have been shown to favorably influence action tremor secondary to head trauma. 1, 5 We have used nadolol to treat successfully two patients with posttraumatic intention tremor. The first patient

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Yoshishige Nagaseki, Tohru Shibazaki, Tatsuo Hirai, Yasuhiro Kawashima, Masafumi Hirato, Hirochiyo Wada, Mizuho Miyazaki and Chihiro Ohye

tremor or posttraumatic tremor), low-frequency tremor (less than 4 Hz), high-amplitude tremor (more than 600 µ V), and tremor that involves proximal muscles or is widely distributed; however, for parkinsonian and essential tremor, the lesion can be very small (about 40 cu mm). 9 In this paper, we report the long-term results of VIM-thalamotomy with minimal lesions for parkinsonian and essential tremor, and discuss some issues relevant to the treatment of tremor. Clinical Material and Methods Patient Population From a series of stereotaxic operations

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Letters to the Editor To The Editor B. Ramamurthi , F.R.C.S. Dr. Achanta Lakshmipathi Neurosurgical Centre Madras, India 787 787 In their article on selective nucleus ventralis intermedius (VIM)-thalamotomy (Nagaseki Y, Shibazaki T, Hirai T, et al: Long-term follow-up results of selective VIM-thalamotomy. J Neurosurg 65: 296–302, September 1986), Nagaseki, et al. , concluded that VIM-thalamotomy for parkinsonism and essential tremors is effective when the lesion is minimal (40 cu mm). They also mentioned

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Frederick A. Lenz, Jonathan O. Dostrovsky, Hon C. Kwan, Ronald R. Tasker, Katsumi Yamashiro and John T. Murphy

figurine shown in Fig. 1E . Stimulation at frequencies in the range of 60 to 500 Hz were about equally effective in generating responses, while thresholds were higher at frequencies outside this range. In a few cases short stimulus trains (< 0.5 sec) were delivered and were found to produce identical sensations, although single pulses never did. Clinical Results These techniques have now been applied during localization of subcortical targets in 38 patients suffering from chronic pain, Parkinson's disease, dystonia, and cerebellar and essential tremor using a

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Frank H. Tomlinson, Clifford R. Jack Jr. and Patrick J. Kelly

Patient Population Twenty-one patients with movement disorders who underwent rf ventralis lateralis thalamotomy carried out by one of the authors (P.J.K.) were studied with postoperative MR studies. Of these 21 patients, surgery was performed for the control of parkinsonian tremor in 14 cases, intention tremor in six, and essential tremor in one. Magnetic Resonance Imaging All postoperative MR studies were performed at 1.5- tesla using a standard 30-cm coil. * Imaging parameters varied slightly between patients, but all underwent a minimum of two primary

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Mary A. Foulkes

institution, who enrolls, and who receives a particular intervention. 5, 7 For example, Lou and Jankovic 27 discussed the potential for selective referral to their movement-disorder clinic and thus to their data base on essential tremor. Designing a population-based data base and renouncing inappropriate treatment comparisons will help to avoid these selection biases. Ascertainment bias can also be affected by interventions that may result in differences in the timing and intensity of monitoring patients. In this case, whether the response is observable is not independent

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. Zabramski Richard A. Flom Richard S. Zimmerman June 1992 76 6 918 923 10.3171/jns.1992.76.6.0918 The symptomatic and functional outcome of stereotactic thalamotomy for medically intractable essential tremor Marc S. Goldman J. Eric Ahlskog Patrick J. Kelly June 1992 76 6 924 928 10.3171/jns.1992.76.6.0924 Results of a prospective randomized trial for treatment of severely brain-injured patients with hyperbaric oxygen Gaylan L. Rockswold Sandra E. Ford David C. Anderson Thomas A. Bergman Robert E

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Marc S. Goldman, J. Eric Ahlskog and Patrick J. Kelly

ventralis lateralis (VL) thalamotomy in essential tremor are not commonly reported, and functional outcome has not been investigated previously. Unlike other movement disorders where functional improvement may not accompany symptomatic improvement after thalamotomy, 7, 18 essential tremor is a monosymptomatic disorder that provides a unique opportunity for significant functional improvement with effective treatment. This study explored the symptomatic and functional impact of thalamotomy on patients with unequivocal severe essential tremor. Clinical Material and