Management of Tremors other than Essential Tremor and Parkinson’s Disease

Abstract

Resting tremor is mainly observed in Parkinson’s disease, and postural tremor mainly corresponds to essential tremor. These two types of tremor are well known and generally respond very well to stereotactic techniques targeted on the ventral intermediate nucleus (Vim) of the thalamus: thalamotomy or Vim stimulation. As indicated in other chapters, the currently preferred stimulation techniques are associated with a much lower risk of neurological sequelae. The third main group of tremor consists of so-called action tremor. This type of tremor is more complex, comprising a postural tremor component and an intention tremor component. Action tremor generally has a larger amplitude than the other two forms and predominantly involves proximal muscles. Action tremor very rapidly becomes disabling and surgery may be considered soon after its onset. There are many causes of action tremor, but the leading causes are multiple sclerosis and head injury. Stereotactic techniques are the same as for Parkinsonian and essential tremor, but the results are generally less favorable, as the functional result largely depends on the neurological signs associated with the tremor: motor deficit, cognitive deficit, cerebellar syndrome, and especially dystonia, which is often present in these patients.