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Topic: Thalamotomy

In the News (Sat 26 Dec 09)

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	Thalamotomy Pallidotomy and Deep Brain Stimulation Adverse Effects and Outcomes Abstracts 2000
		The neuropsychological results are in a strict sense confined to thalamotomy and thalamic stimulation, although the more general message of the importance of investigating cognitive functions before and after surgery applies to other stereotactic techniques for surgical treatment of movement disorders as well.
		It is argued in the paper that stereotactic thalamotomy provides a unique model for basic research on the neuropsychology of the thalamus, while in return, neuropsychological tests for cognitive dysfunction after surgery may be the most important clinical follow-up.
		Second thalamotomy, contralateral to the initial side, may be indicated if the ADL deteriorates due to the progression of the symptoms on the non-treated side.
	www.parkinsons-information-exchange-network-online.com /archive/tpd.html (3120 words)

	World of MS - Symptoms & Treatments - Thalamotomy, Thalamic Stimulation (Site not responding. Last check: 2007-11-05)
		Surgeons currently are turning away from thalamotomy because of the attendant risks and implanting electrodes in the same part of the brain as a less dangerous means of controlling tremor.
		Thalamotomy on one side may result in weakness of the arm and leg on the opposite side, disturbance of recent memory, or speech and language disturbance; these may be due to enlargement of the operative wound by bleeding, especially in patients with high blood pressure.
		Based on the evidence examined, thalamotomy and thalamic stimulation are not recommended for MS except in a small number of carefully selected MS patients, and even there the beneficial effect is of limited duration and is associated with substantial risks.
	www.msif.org /en/symptoms_treatments/ms_the_guide_to_treatment_and_management/alternative_therapies_used_by_people_with_ms/miscellaneous_empirical_treatments/physical_and_surgical_manipulations/thalamotomy_tha.html (384 words)

	thalamotomy
		Thalamotomy is a neurosurgical procedure, first introduced in the 1950s for the treatment of Parkinson's type tremor, that selectively lesions a part of the ventrolateral thalamus.
		Neither thalamotomy nor pallidotomy are experimental, and refinements in these procedures are ongoing as more patients are followed for longer periods of time.
		The complementary therapeutic effects of PVP and Vim thalamotomy may be due to the interruption of different neuronal circuits by the two procedures.
	www.pallidotomy.com /thalamotomy.html (960 words)

	THALAMOTOMY AND PALLIDOTOMY - Neurosurgical Service - Massachusetts General Hospital
		In thalamotomy, the goal is to permanently abolish tremor or other disabling involuntary movement disorder such as hemiballismus, chorea or dystonia by placing a small lesion in the Vim nucleus of the thalamus.
		Thalamotomy is performed under local anesthesia and requires the full cooperation of the patient therefore the intraoperative use of sedating agents must be avoided.
		The typical thalamotomy target is the Vim nucleus and occasionally, the mere introduction of the electrode reduces the tremor indicating that the electrode is in good position.
	neurosurgery.mgh.harvard.edu /Functional/pallidt.htm (9516 words)

	The Mount Sinai Clinical Program for Stereotactic and Functional Neurosurgery - Department of Neurosurgery - Mount ... (Site not responding. Last check: 2007-11-05)
		Thalamotomy is an ablative surgical procedure developed in the 1950s aimed to destroy small parts of the thalamus, a part of the basal ganglia system.
		Thalamotomy is indicated for patients who are affected by tremor, Parkinson's disease, or essential tremor.
		Thalamotomy can also be helpful for other types of tremor, such as traumatic, stroke, and multiple sclerosis tremor and for other movement disorders, such as dystonia.
	www.mssm.edu /neurosurgery/stereotactic/thalomotomy.shtml (468 words)

	Thalamotomy for Parkinson's disease
		Thalamotomy is the precise destruction of a tiny area of the brain called the thalamus that controls some involuntary movements.
		Thalamotomy may be considered as an addition to levodopa therapy, not as a replacement for it.
		Thalamotomy usually is not done on both sides of the brain because it greatly increases the risk of speech and cognitive problems after surgery.
	my.webmd.com /hw/parkinsons/aa140809.asp (700 words)

	Surgery for Intractable Tremor - Neurosurgical Service - Massachusetts General Hospital
		The greater functional improvement in the thalamic stimulation group as compared to the thalamotomy group my be attributable to reduced side effects, to the fact that the amount of current can be titrated in the stimulation group to maximize benefit while avoiding side-effects, or to a different mechanism of action of stimulation.
		Thalamotomy can not be performed bilaterally due to the increased risk of neurologic complications such as hypophonia, dysarthria and cognitive deficits.
		However, thalamotomy is still an effective and well-proven technique that can be used that can be used when patients decide against a stimulator or when other considerations mitigate against the placement of a stimulator.
	neurosurgery.mgh.harvard.edu /functional/IntractableTremor.htm (4652 words)

	Thalamotomy Abstracts 2000
		Conclusions: Medial thalamotomy or pallido-thalamic tractotomy had acute and reversible effects on the EEG and long-term deleterious side effects of stereotactic surgery on sleep and sleep EEG are improbable.
		Thalamotomy resulted in a reduction of FDG uptake in predominantly the lateral prefrontal- and the parietal cortex, whereas pallidotomy affected only uptake in the (pre)frontal cortex.
		Ventralis intermedius (Vim) DBS has virtually replaced thalamotomy in the routine clinical treatment of essential tremor, affording relief to thousands of patients who previously would not have undergone surgery, and there is increasing usage of Vim DBS in other tremors of intention (e.g., multiple sclerosis).
	www.parkinsons-information-exchange-network-online.com /archive/thalamot.html (3540 words)

	Korean Journal of Radiology
		In recent years, increasing interest has been shown in the stereotactic neurosurgical treatment (radiofrequency thalamotomy or pallidotomy) of the condition (4-9), and in the post-levodopa era, stereotactic thalamotomy has been reconsidered as a viable alternative in the treatment of parkinsonian tremor (10, 11).
		Among those who underwent thalamotomy, decreased ratios were observed in the substantia nigra and thalamus of 80% (12/15) and 67% (10/15), respectively.
		The mechanism of action of thalamotomy is not known but may involve the destruction of autonomous neural activity, that is, of synchronous bursts that fire at the same frequency as limb tremor.
	www.kjronline.org /abstract/view_articletext.asp?year=2002&page=180 (4442 words)

	existing
		Thalamotomy and Pallidotomy have existed since the late 1940s; these surgical procedures were not used in the 1970s to early 80s due to the effectiveness of a less invasive, orally administered levodopa.
		Procedure for thalamotomy is similar with the exception of lesioning various points in the thalamus (anteriorly for rigidity, posteriorly for tremor).
		Their development raises questions such regarding who gets the treatment, the ethics of using aborted fetuses as donors, and the fairness of 'placebo' surgeries, where holes are made in the patient while he/she is secretly denied of the implant cells.
	biomed.brown.edu /Courses/BI108/BI108_1999_Groups/Neuroelectrodes_Team/existing.html (966 words)

	Essential Tremor / Stereotactic Radiosurgery
		For radiofrequency thalamotomy, the complication rate has been variously estimated from as low as five percent to as high as 20% or 25%.
		Deep brain stimulation may be particularly useful if a thalamotomy has been performed previously on one side and one is interested in controlling tremor on the other side.
		This risk may be lowered by performing a thalamotomy on one side and then placing a deep brain stimulator on the other side.
	www.irsa.org /essential_tremor.html (1836 words)

	Treatments for Parkinson's Disease, Conventional Western Treatment, Levodopa/PDI therapy, COMT ...
		Thalamotomy was widely used in the treatment of Parkinson's disease about 30 years ago.
		Thalamotomy and thalamic stimulation are effective for ameliorating medically refractory tremor.
		Thalamotomy, a surgical procedure that destroys a specific group of cells in the thalamus, the brain's communications center, is aimed at the 5 to 10 percent of Parkinson's patients with disabling tremor in the hand or arm.
	www.holistic-online.com /Remedies/Parkinson/pd_treatments.htm (1675 words)

	[No title] (Site not responding. Last check: 2007-11-05)
		Both thalamotomy and thalamic stimulation are linked with a minimal overall risk of cognitive deterioration in patients with severe drug-resistant tremor.
		Six months after the thalamotomy, there was a decline in the scores of the Stroop Color-Word Test, with the exception of the interference score.
		After both thalamotomy and thalamic stimulation, study indicated there was a difference in score changes between right- and left-sided surgery in verbal fluency and Stroop Test scores.
	www.mult-sclerosis.org /news/Nov2002/ThalamotomyvsThalamicStimulationforTremor.html (259 words)

	Reviews in Neurosurgery Vol 1, No 3 (Site not responding. Last check: 2007-11-05)
		Nowadays surgical options to treat PD include lesioning (thalamotomies and pallidotomies), deep brain stimulation (nucleus ventralis intermedius of the thalamus, internal segment of the globus pallidus and subthalamic nucleus) and implantation of cells into a target site attempts to replace neurons that have died from disease process.
		Although thalamotomy and thalamic DBS may be performed under local anesthesia, there are a group of patients who have conditions that predispose them to a high risk from invasive procedures.
		The thalamotomy procedure was developed almost 50 years ago and is currently considered a treatment of choice for unilateral or predominantly unilateral tremor.
	www.wfns.org /principal_reviews7_3.html (6497 words)

	American Family Physician: Thalamic Implants in Patients with Refractory Tremor
		For patients with incapacitating tremor that is refractory to drug therapy, thalamotomy is effective for 73 to 93 percent of patients, but it carries a complication rate of 9 to 23 percent in patients with Parkinson's disease or essential tremor, and a complication rate of 16 to 41 percent in patients with multiple sclerosis.
		Patients with bilateral tremor were randomized to undergo bilateral implantation of electrodes in one session or unilateral thalamotomy directed at the hand with the most severe tremor with contralateral electrode implantation performed six months later.
		In the thalamotomy group, the mean age was 64 years, and in the thalamic stimulator group, it was 59 years.
	www.findarticles.com /p/articles/mi_m3225/is_10_61/ai_62829166 (807 words)

	pallidotomy (Site not responding. Last check: 2007-11-05)
		Stereotactic thalamotomy has traditionally provided good relief of tremor for patients with intractable tremor-dominant PD. However, bradykinesia and akinesia are unaltered by this technique.
		We have performed and published on combined Vim/VOP thalamotomy and PVP unilaterally during one surgical sitting for 29 patients with significant tremor with excellent results on the unilateral akinetic and hyperkinetic PD symptoms.
		Thalamotomy, in which lesions are placed in the ventrolateral thalamus, replaced pallidotomy.
	www.pallidotomy.com /pallidotomy.html (3105 words)

	AANS.org \| Education and Meetings \| AANS Scientific Journals \| Neurosurgical Focus
		Radiosurgical nucleus ventralis intermedius thalamotomy using the gamma knife unit was performed to make 38 lesions in 24 men and 10 women (median age 73 years, range 58--87 years) over a 5-year period.
		In our series, 22 thalamotomies were performed using an average maximum dose of 120 Gy and 16 thalamotomies were performed using an average dose of 160 Gy.
		Gamma knife radiosurgery for thalamotomy is an effective and useful alternative to invasive radiofrequency techniques in patients at high risk for surgery.
	aans.org /education/journal/neurosurgical/mar97/2-3-12.asp?... (3060 words)

	WE MOVE - Surgical Treatment of Dystonia
		Thalamotomy and pallidotomy, which are surgeries used to treat individuals with Parkinson's disease, are now used to treat those with dystonia.
		During a stereotaxic thalamotomy, a selected portion of the thalamus is surgically destroyed (ablated).
		Deep Brain Stimulation (DBS) is an invasive surgical procedure that seems to mimic the positive effects of surgical ablation performed during a thalamotomy or pallidotomy.
	www.wemove.org /dys/dys_sur.html (800 words)

	From the Cleveland Clinic: Surgical Treatments: Pallidotomy and Thalamotomy
		Thalamotomy destroys part of the thalamus to block the abnormal brain activity from reaching the muscles and causing tremor.
		Because thalamotomy is used only to control tremors, it is not generally recommended as a treatment for Parkinson's disease.
		Although thalamotomy and pallidotomy surgeries are still done today, they are done less frequently because of the risk of serious side effects and the availability of deep brain stimulation, which is safer and has fewer complications.
	my.webmd.com /content/article/46/1833_50760.htm (227 words)

	Outcome microelectrode-guided stereotactic pallidotomy and thalamotomy in 71 patients with Parkinson’s diseasa (Site not responding. Last check: 2007-11-05)
		Both of ventrolateral thalamotomy and posterovental pallidotomy have been demonstrated (1) to be an effective teatment for select patients with medically refractory Parkinson’s disease.
		Abnormal neuronal electric activity was monitored in ventrolateral thalamotomy, and in posterovental pallidotomy it is important to distinguish GPi (globus pallidus internus) and GPe (globus pallidus externus), and locate the optic tract.
		In thalamotomy one patient received 3-5 lesions on the same electrode trajectory, but spaced within 1mm of one another, and in pallidotomy one patient received 5-7 lesions.
	www.cmj.org /netprints/01/02/010201.htm (2017 words)

	ICPD: Thalamotomy As Effective As Thalamic Stimulation For Tremor Control (Site not responding. Last check: 2007-11-05)
		Thalamotomy has long been used for the control of tremor, though in recent years it has been rivaled by thalamic stimulation via implanted electrodes.
		To compare the safety and efficacy of both treatment approaches, Dr. Schuurman randomized 70 patients to one or the other procedure, and rated their improvement on tremor and functional ability at six months and two years.
		Schuurman said that, since both treatments had roughly similar outcomes, thalamotomy, which is easier and requires no expensive post-operative adjustments, remains a useful procedure for tremor suppression.
	www.pslgroup.com /dg/2021E6.htm (397 words)

	eMedicine - Surgical Treatment of Tremor : Article by Michele Tagliati, MD (Site not responding. Last check: 2007-11-05)
		Thalamotomy is indicated in patients with PD who are disabled by medically refractory tremor.
		As with thalamotomy, thalamic DBS uncommonly provides significant functional improvement for patients with PD because their rest tremor is not usually a source of functional disability.
		Thalamic stimulators and thalamotomies to treat tremor are placed at the junction of the ventral intermediate and ventral oral posterior nuclei.
	www.emedicine.com /neuro/topic582.htm (2938 words)

	Medtronic News Releases (Site not responding. Last check: 2007-11-05)
		While both groups experienced similarly high levels of reduction in their tremor, patients who received thalamic stimulation outscored those who underwent thalamotomy on measures assessing improvements in 15 activities of daily living, including domestic tasks, leisure or work-related activities, and outdoor activities.
		In the study, 91 percent of the thalamic stimulation group and 79 percent of the thalamotomy group experienced total or almost complete suppression of their tremor after treatment.
		Adverse effects such as slurred speech and gait or balance abnormalities were more common among patients in the thalamotomy group than in the thalamic stimulation group -- 16 patients compared to six, respectively, after six months.
	www.mymedtronic.com /newsroom/news_20000217075013.html (726 words)

	Pallidotomy, Thalamotomy, Deep Brain Stimulator NoFrames
		At the same time, many surgeons were performing surgery on the thalamus and for a variety of reasons, thalamotomy became widely accepted, replacing pallidotomy as the surgical treatment of choice for Parkinson's Disease.
		Thalamotomy, which has an excellent effect on the tremor, is not as effective at reducing rigidity, bradykinesia, or hypokinesia.
		This is especially common with bilateral thalamotomies for tremor but is not a common permanent effect of deep brain stimulators.
	www.wfubmc.edu /surg-sci/ns/md-surg0.html (2978 words)

	Stereotactic thalamotomy in the treatment of essential tremor of the upper extremity: reassessment including a blinded ...
		Stereotactic thalamotomy in the treatment of essential tremor of the upper extremity: reassessment including a blinded measure of outcome -- Zirh et al.
		Stereotactic thalamotomy in the treatment of essential tremor of the upper extremity: reassessment including a blinded measure of outcome
		Thalamotomy has been reported in small series to be an effective therapy for the treatment of medically intractable essential
	www.jnnp.com /cgi/content/full/66/6/772 (1793 words)

	Gamma knife radiosurgery as a lesioning technique...
		Our success rates based on clinical evaluations for thalamotomy for tremor control and pallidotomy for control of bradykinesia, rigidity, and levodopa-induced dyskinesias are very similar to those reported for open stereotactic procedures of a similar type.
		For thalamotomy the efficacy of the procedure as assessed clinically was confirmed by the UPDRS scores without a change in Hoehn and Yahr scores.
		Additionally, Jankovic, et al., reported that an initial thalamotomy failed to give lasting relief of tremor in nine of 60 patients and these lesions were enlarged during second procedures performed an average of 2 months after the initial procedures.
	www.c3.hu /~mavideg/jns/2-3-11.html (5487 words)

	BCMA > BC Medical Journal > Issues > BCMJ May 2001 Edition
		Fewer pallidotomies were performed after the introduction of levodopa and the realization that thalamotomy was better at tremor reduction than pallidotomy.
		Patients who are not good candidates for thalamotomy have cognitive impairment, dysarthria, or PD symptoms other than tremor as the major problem.
		We are using thalamic stimulation in BC for PD patients with tremor who already have had a thalamotomy on the other side or who have tremor due to multiple sclerosis (where a lesion could spontaneously occur on the other side).
	bcma.org /public/bc_medical_journal/BCMJ/2001/may_2001/PDSurgery.asp (2049 words)

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