Objective: Analyse our experience with Stereotactic lesioning for  multi-etiological tremor.

Background: Lesioning in tremor had been one of the most widely used procedures before the advent of Deep Brain Stimulation (DBS). Lesioning does have a role in the management of tremor especially unilateral tremor even in this present era. Here we present our experience in the use of stereotactic lesioning in the management of patients with multi-etiological tremors.

Method: Patients with medically refractory tremor of varying aetiologies ( Parkinson disease, PKAN, Wilson Disease, Essential tremor)  who underwent  stereotactic lesioning surgery were included in the analysis. A comprehensive clinical-radiological evaluation was performed preoperatively and 3 months and 1 year postoperatively.

Results: A total of 52 patients (38 men, 14 women) with an average age 42.7 years (range 21–65 years) underwent stereotactic thalamotomy/subthalamotomy at our institute between 2008 and 2018, for the treatment of medically refractory tremor of varying etiologies. The mean preoperative duration of symptoms was 13 years (range 10 months to 34 years). The median time to onset of improvement was 6 weeks (range 1 week to 8 months). Analyzing the improvement on the modified FTM scale, in part 1 the scores improved from 22.78 to 1.4, the part II subset improved from an average of 9.4 to 3.4 while the part III subset improved from an average of 14.1 to 4.1 postoperatively. This implied an excellent response in tremor.

Conclusion: In this study we discuss our experience that tremor of various etiologies respond extremely well to lesioning surgery. While DBS continues to remain the treatment of choice in various types of bilateral tremor, lesioning is very successful in a carefully selected cohort of patients. We are of the opinion that in predominantly unilateral tremor or when the patient cannot afford DBS especially in a country like ours, lesioning surgery is an important tool in the armamentarium of the functional neurosurgeon.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/efficacy-of-stereotactic-lesioning-in-multi-etiological-tremor/