Deep brain stimulation is preferable to thalamotomy for tremor suppression

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. 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. 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. 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.