8
Evaluation Management
Table 4. Surgical Treatment Options
Deep Brain Stimulation (DBS)
Surgical Method Stimulation: an electrode is placed in the brain and connected to
a pulse generator typically located in the chest to provide electrical
stimulation to the brain.
Brain Site VIM nucleus of the thalamus
Status During
Surgery
Awake or asleep under general anesthesia
Time to Benefit Immediate
Pros • No destruction of brain tissue
• Stimulation can be adjusted to increase benefit or reduce side
effects without further surgery
• Device can be repositioned to increase benefit or reduce side effects
• Can have bilateral procedures
• Can be removed — reversible
• Electrophysiologic confirmation of target
Cons • Requires periodic adjustments
• Requires battery changes or re-charging
• Foreign material implanted in body — increased risk of wound
infection and other complications
• Head partially shaved
• Pre-existing cognitive issues could worsen
Outcomes • 50–75% tremor reduction (unilateral)
• 65–80% tremor reduction (bilateral)
Complications • Surgical (<5%) — intracranial hemorrhage, infection, edema
• Device related (<5%) — hardware malfunction, misplaced or
migrating leads, erosion
• Stimulation related — paresthesia, gait disturbance, dysarthria
Surgical Treatment Options
• Patients whose tremor is not controlled by pharmacological therapies may be
candidates for surgical treatment options that include deep brain stimulation
(DBS), focused ultrasound (FUS) and gamma knife radiosurgery (GKR).
