Deep brain stimulation is preferable to thalamotomy for tremor suppression.

BACKGROUND: The use of deep brain stimulation (DBS) at a site identical to that of thalamotomy is becoming increasingly popular for the control of tremor. It therefore seemed reasonable to compare the two operations.

METHODS: A retrospective comparison was made of 19 DBS implants--16 for Parkinson's disease (PD), 3 for essential tremor (ET)--and 26 thalamotomies--23 for PD and 3 for ET--performed by the author with similar techniques between November 1, 1990 and July 1, 1996 and followed for at least 3 months.

RESULTS: Complete tremor abolition occurred in 42% of both groups, near abolition in 79% and 69% respectively, recurrence in 5% and 15%, respectively. To achieve these results, 15% of thalamotomies, but no DBS implant, had to be repeated. Thus tremor recurrence after DBS can be controlled by stimulation parameter adjustment rather than by re-operation. A "microthalamotomy" effect from merely implanting an electrode, seen in 53% of cases and persisting for more than 1 year in five cases, prognosticated a good result and underlined the need for precision in target site selection. Ataxia, dysarthria, and gait disturbance were more common after thalamotomy (42%) than DBS (26%), but when they occurred after DBS they could nearly always be controlled by adjusting stimulation parameters.

CONCLUSIONS: Thus, the flexibility of DBS for tremor control and complication avoidance makes it superior to thalamotomy for tremor control at the expense of equipment cost and continual management.