[Stereotactic ventrolateral thalamotomy in the treatment of Holmes tremor].

BACKGROUND AND PURPOSE

The authors report the results of stereotactic surgery for severe posttraumatic tremor in 7 patients.

MATERIAL AND METHODS

All patients were severely incapacitated in their daily living activities by mainly kinetic and postural components of Holmes tremor. The 7 patients underwent 8 stereotactic operations. The stereotactic target in all patients was the ventrolateral thalamus. Patients were evaluated using the Clinical Rating Scale For Tremor (CRST) before and up to 24 months after stereotactic thalamotomy.

RESULTS

In the postoperative period there was marked amelioration in kinetic and postural components of Holmes tremor in contralateral upper and lower extremity. The mean presurgery value for contralateral upper extremity kinetic tremor (scores 5-6 CRST) dropped from 3.25 to mean postsurgery value of 0.5. There was also a marked functional improvement. It was reduced from a mean value of 71% of maximum disability according to CRST (scores 15-21, part C CRST, 0% independent, 100% total dependent) to 28.5% over 2-year follow-up.

CONCLUSIONS

Ventrolateral thalamotomy alleviates effectively Holmes tremor and improves greatly performance of activities of daily living.