The clinical indication for surgical treatment for tremor patients is for pharmacoresistant patients. This means that the tremor did not respond at least of two pharmacological therapies or the patients could not tolerate the medication. The clinical factor that guide the decision towards a surgical treatment are the severity of the tremor, the phenotype, so the distribution of the tremor, the age of the patients and comorbidities such as balance and gate impairment, cognitive difficulties...
The clinical indication for surgical treatment for tremor patients is for pharmacoresistant patients. This means that the tremor did not respond at least of two pharmacological therapies or the patients could not tolerate the medication. The clinical factor that guide the decision towards a surgical treatment are the severity of the tremor, the phenotype, so the distribution of the tremor, the age of the patients and comorbidities such as balance and gate impairment, cognitive difficulties. The surgical option available for pharmacoresistant tremor syndromes are deep brain stimulation, MRI guided focused ultrasound, radio frequency, and gamma knife stereotactic surgery. The most established and especially used surgery is deep brain stimulation, where the electrodes are implanted in some part of the brain for essential tremor that is most common tremor syndrome. The target is the talamus. However, the most important clinical indication to take into account is the age because that is an age limit up to 75 year old for the patient. MRI guided focused ultrasound does not have any strict age limit for the inclusion in this surgery. And the radio frequency and gamma knife were very commonly used especially before the emerging of MRI guided focused ultrasound. The efficacy is comparable across all these different type of surgery, however the longest follow-up data that we have is for DBS, radio frequency, and gamma knife because they have been on the market for longest time. So we don’t have an answer in the in the terms of very long efficacy for MRI guided focused ultrasound.
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