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James W. Little, Kim Burchiel and Paul Nutter

A lthough tremor is often associated with central nervous system (CNS) disease, it has been described in patients with peripheral nerve disease and no evidence of CNS dysfunction. 1, 7 Tremor due to peripheral neuropathy has usually been seen in acquired or hereditary polyneuropathy. Only a few cases of tremor in association with nerve injury or entrapment have been described. 7 We present the case of a patient with localized tremor accompanying peripheral nerve entrapment and we outline the effects of surgical release on that tremor. Case Report This

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Stereotactic radiosurgery for tremor: systematic review

International Stereotactic Radiosurgery Society practice guidelines

Nuria E. Martínez-Moreno, Arjun Sahgal, Antonio De Salles, Motohiro Hayashi, Marc Levivier, Lijun Ma, Ian Paddick, Jean Régis, Sam Ryu, Ben J. Slotman and Roberto Martínez-Álvarez

T he most common movement disorder is tremor, either essential tremor (ET) or tremor arising in the course of other disorders, chiefly Parkinson’s disease (PD). It tends to increase as the underlying disorder progresses and with age, 44 impairing performance and coordination of voluntary movements. Even mild cases affect the quality of a patient’s personal and working life. 38 , 43 , 50 , 71 Neurosurgery is the therapeutic option when initial pharmacological treatment fails or is contraindicated. The ventral intermediate nucleus (VIM) of the thalamus was

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Jason A. Brodkey, Ronald R. Tasker, Clement Hamani, Mary Pat McAndrews, Jonathan O. Dostrovsky and Andres M. Lozano

M icroelectrode recordings during stereotactic surgery have shown that tremor disorders are characterized by the presence of neurons in the ventral thalamus that have a spontaneous rate of discharge synchronous with peripheral tremor. These neurons are known as TRA cells or tremor cells. Although the pathogenesis of tremor remains unclear, a large body of evidence indicates that TRA cells play an important role. 2 Indeed, the aim of surgical interventions for the treatment of tremor disorders is to disrupt the activity of TRA cells in the region of the Vim

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Kalman Katlowitz, Mia Ko, Alon Y. Mogilner and Michael Pourfar

D eep brain stimulation (DBS) of the subthalamic nucleus (STN) has become a part of the standard of care in the management of select patients with Parkinson disease (PD) since its introduction in the 1990s. 4 , 20 , 24 Its efficacy for the management of PD tremor in particular has been repeatedly demonstrated in several large cohorts with reductions often on the order of 75%–90%. 3 , 11 This consistent improvement, however, is often reported as an aggregate result, with less attention directed to the impact of stimulation specifically on chin, arm, and leg

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Jamal M. Taha, Jacques Favre, Thomas K. Baumann and Kim J. Burchiel

T halamotomy has been the preferred surgical treatment for parkinsonian tremor for the past 30 years. 3, 8, 10 Tremor is abolished in 86 to 95% of patients with Parkinson's disease after this procedure; 3, 8, 12, 16 however, the effects of thalamotomy on other symptoms of Parkinson's disease (that is, bradykinesia, rigidity, dystonia, drug-induced dyskinesia, and on—off fluctuations) have been inconsistent. 3, 8 For amelioration of the latter symptoms, posteroventral pallidotomy has proved to be a more effective surgery. 2, 5, 9, 11, 14 Currently

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Nirit Weiss, Richard B. North, Shinji Ohara and Frederick A. Lenz

T remor is the most common manifestation of a movement disorder, 8 and it may range in severity from mildly embarrassing to severely disabling. This symptom is usually described as either rest tremor or action tremor, and the latter can be further divided into essential, cerebellar, and physiological tremor, among others. Tremor can be the primary manifestation of certain disease states, as in the resting tremor of Parkinson disease and the postural tremor of essential tremor, or caused by the underlying pathological features of more diffuse disease states

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Jamal M. Taha, Michele A. Janszen and Jacques Favre

D eep brain stimulation (DBS) of the ventralis intermedius nucleus (Vim) is an effective treatment of limb tremor accompanying Parkinson's disease, essential tremor, and multiple sclerosis. 6, 15, 16 In most studies of DBS of the Vim, the results of unilateral thalamic stimulation for the control of contralateral limb tremor have been reported. 6, 7, 16, 17, 33 Deep brain stimulation is approved by the United States Food and Drug Administration for the unilateral implantation of electrodes in the Vim to control tremor of the contralateral limb. Some patients

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Thomas M. Kinfe, Hans-Holger Capelle and Joachim K. Krauss

P osterior fossa tumors may cause a variety of neurological symptoms either by direct invasion of eloquent areas of the brainstem or the cerebellum or by compression of adjacent structures. 4 , 11 , 19 , 33 , 34 Occasionally, posterior fossa tumors or cysts may manifest in unilateral tremors. 10 , 12 , 35 These tremors are usually accompanied by hemiataxia, and they are best classified as postural and kinetic tremors. Little is known about the course and development of tumor-related tremors after surgical removal of the offending lesions. Therefore, the

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Caglar Berk and Christopher R. Honey

T halamic deep brain stimulation is a well-recognized and effective treatment for upper-limb tremor. 1–5, 10, 13, 16, 24 Patients with essential tremor, however, can experience tremor affecting the head, voice, and upper limbs. 6 Usually head tremor does not begin until after limb tremor is well established. Treatment of disabling limb tremor can have a beneficial side effect of improving head tremor; 16, 22, 28 however, to our knowledge, there have been no reports of the use of thalamic DBS in patients in whom head tremor is the presenting symptom. We

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Mark W. Fox, J. Eric Ahlskog and Patrick J. Kelly

P arkinson's disease is irreversible, progressive, and characterized by resting tremor, rigidity, bradykinesia, and postural instability. 2, 5, 13, 14, 25 In the pre-levodopa era, stereotactic thalamotomy was one of the few alternatives for treating this condition. 24, 34, 37 With the advent of levodopa and related medications, thalamotomy was almost abandoned as treatment for parkinsonian tremor. This waning enthusiasm for thalamotomy was, in part, related to its somewhat inconsistent results and complications associated with earlier stereotactic surgical