Treatment of Essential Tremor: Deep Brain Stimulation

Deep brain stimulation (DBS) of the ventralis intermedialis nucleus of the thalamus (VIM) for essential tremor (ET) is recommended for medication-refractory patients with significant tremor that impacts on activities of daily living or quality of life. Patients should be made fully aware of the potential benefits and complications of surgery and that their expectations are realistic. The most important issues regarding DBS are that the diagnosis is correct, that the patient has had an adequate trial of medical therapy, and that the odds of improvement are substantial when weighed against the risks. Consideration must also be given to physical, psychological, and socioeconomic issues. The potential of DBS to keep patients employed and functioning socially should be the highest priority. Although VIM DBS is the surgical treatment of choice in ET, newer ablative approaches, such as focused ultrasound, should be discussed.