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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

G , Jordan J : Sympathetic activation due to deep brain stimulation in the region of the STN . Neurology 65 : 774 – 775 , 2005 10.1212/01.wnl.0000174436.36399.ca 9 Loewy AD : Forebrain nuclei involved in autonomic control . Prog Brain Res 87 : 253 – 268 , 1991 10.1016/S0079-6123(08)63055-1 10 Louis ED : Essential tremor . Lancet Neurol 4 : 100 – 110 , 2005 10.1016/S1474-4422(05)00991-9 11 Murata J , Kitagawa M , Uesugi H , Saito H , Iwasaki Y , Kikuchi S , : Electrical stimulation of the posterior subthalamic area for

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Sachiko Kato, Satoshi Maesawa, Epifanio Bagarinao, Daisuke Nakatsubo, Takahiko Tsugawa, Satomi Mizuno, Kazuya Kawabata, Takashi Tsuboi, Masashi Suzuki, Masashi Shibata, Sou Takai, Tomotaka Ishizaki, Jun Torii, Manabu Mutoh, Ryuta Saito, Toshihiko Wakabayashi, Masahisa Katsuno, Norio Ozaki, Hirohisa Watanabe, and Gen Sobue

F or the last decade, MR-guided focused ultrasound (MRgFUS) thalamotomy has been attracting attention as a novel treatment for essential tremor (ET) with favorable outcomes reported by many institutions worldwide. 1 – 3 A target structure for this treatment is the ventral intermediate nucleus (Vim) in the thalamus in order to modify the abnormality in the cerebello-thalamo-cortical network, considered the main pathological basis in ET. 4 – 6 Recently, however, instead of considering ET as a single pathological disease, different pathological conditions

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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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G. Rees Cosgrove, Nir Lipsman, Andres M. Lozano, Jin Woo Chang, Casey Halpern, Pejman Ghanouni, Howard Eisenberg, Paul Fishman, Takaomi Taira, Michael L. Schwartz, Nathan McDannold, Michael Hayes, Susie Ro, Binit Shah, Ryder Gwinn, Veronica E. Santini, Kullervo Hynynen, and W. Jeff Elias

T ranscranial MRI-guided focused ultrasound (MRgFUS) thalamotomy of the ventral intermediate (Vim) nucleus for the treatment of essential tremor (ET) is a recently developed, incisionless technique incorporating intraprocedural MRI, real-time thermometry, and submillimeter adjustments based on patient feedback prior to lesioning. 1 The ExAblate 4000 system (InSightec Ltd.) and the procedure used for unilateral MRgFUS Vim thalamotomy have been previously described. 1 – 3 A multicenter, randomized, double-blind, sham-controlled trial of unilateral MRgFUS

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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