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Q&A Sessions: Tremor

John Y.K. Lee, MD, Assistant Professor of Neurosurgery, is the Director of the Penn Center for Cranial Nerve Disorders and a national leader in treating cranial nerve disorders.

Bob asks:
My mother (77) suffers from essential tremor and has undergone a deep brain stimulator implant procedure at another well-known hospital. Initially, results were impressive but her condition has deteriorated significantly and daily tasks are difficult to complete. She is in good health, but the tremors are taking a toll on her quality of life. Is a Gamma Knife procedure a possibility after receiving a DBI?

Dr. Lee responds:
Gamma Knife radiosurgery is a possibility but if her tremor is well-controlled, then her deterioration may be due to other causes that cannot be treated with Gamma Knife radiosurgery. I recommend seeing a neurologist.

Kim asks:
If seizures are occuring in an area of the brain where it's too risky to undergo a brain operation as such, would the Gamma Knife be an alternative to correcting complex partial seizures and/or partial complex partial seizures? If so, what chance might there be to become seizure-free?

Dr. Lee responds:
Gamma Knife radiosurgery can be used to treat tumors and thus to control the seizures that are associated with the tumor. Seizure disorder, in absence of a tumor, has only rarely been treated with Gamma Knife radiosurgery.

We would have to consider each case carefully in full consultation with our neurologists. In certain instances, Gamma Knife can be a valuable option for some patients.

If you would like to discuss this further, please call us at 800-789-PENN to schedule an appointment. You can also request an appointment online.

Sondra asks:
I have had Parkinson's disease since I was 53 years old. I am now 71 and the drugs are not as effective. I could not tolerate deep brain stimulation. Can Gamma Knife radiosurgery be utilized? Is it a non-invasive procedure?

Dr. Lee responds:
I have used Gamma Knife radiosurgery in the past to treat patients with Parkinson's disease and essential tremor. It is less commonly used today, because of the success of deep brain stimulation. In select patients, however, Gamma Knife may be the best choice.

I would be happy to discuss this with you. Please call us at 800-789-PENN to schedule an appointment. You can also request an appointment online.

Donna asks:
My mother-in-law has suffered approximately twenty years with an essential tremor that has recently become more pronounced. She is 78 years old and is becoming more and more uncomfortable with this condition. The tremor affects her head and hand.

What success have you had in treating this condition with the Gamma Knife? If you feel she could be helped, we will make appointment with the Center for her. She has been to several neurologists in the past. All have been treating it with various medications.

Dr. Lee responds:
Gamma Knife for essential tremor should only be performed by neurosurgeons who are skilled at both Gamma Knife radiosurgery as well as conventional movement disorder surgery. In addition, each case should be discussed with a team of neurologists.

I am definitely able to counsel you with respect to the treatment of essential tremor with either surgical technique, and please feel free to make an appointment. If you would like more information or to schedule an appointment at the Penn Gamma Knife Center, please call 1-800-789-PENN (7366) or request an appointment online.

Lynn asks:
How successful is Gamma Knife for essential tremor? What are the possible bad side effects? My mother is 82 and has very bad essential tremor and does not want to have open surgery but is in fairly good health otherwise so what health answers should we get before considering Gamma Knife?

Dr. Lee responds:
This is a very good question. Gamma Knife is an alternative method to perform a thalamotomy in patients with severe essential tremor. Its major advantage is that is less invasive. Its major disadvantage is the lack of adjustability during the operative procedure. Hence, this procedure should only be performed by radiosurgeons who are familiar with both the conventional deep brain stimulation or open thalamotomy surgical procedure as well as gamma knife radiosurgery.

If you would like more information or to schedule an appointment at the Penn Gamma Knife Center, please call 1-800-789-PENN (7366) or request an appointment online.

Dave asks:
Would this procedure help with intention tremors caused from young onset Parkinson's Disease? I am a 42 year-old male with the past diagnosis of above.

Dr. Lee responds:
Gamma Knife thalamotomy or pallidotomy is another way to lesion the brain. It is similar to traditional radiofrequency thalamotomy or pallidotomy, but the advantage is that it is less invasive. The disadvantage of the Gamma Knife procedure, however, is that there is no live feedback from the patient while the patient is undergoing the procedure. Hence, Gamma Knife lesioning should only be performed at specialized centers by neurosurgeons who are intimately familiar with both traditional movement disorder surgery (thalamotomy, pallidotomy, and deep brain stimulation) as well as Gamma Knife radiosurgery.

The efficacy of this treatment is not well known at this time. The treatment of movement disorders is complex, and the best surgical procedure for a patient should be made in conjunction with a team of neurologists and neurosurgeons.

Wendy asks:
I work for a company that reviews treatments that are denied by health insurers. Gamma Knife has been denied in the past as well as getting the medical necessity for Movement Disorders. Would you be willing to review any of these cases?

Dr. Lee responds:
Gamma Knife pallidotomy or thalamotomy is a procedure that requires a complex degree of skill and coordination between the neurosurgeon and his/her movement disorder neurologist. I think it is important for the particular neurosurgeon to have skill at both open pallidotomy/thalamotomy as well as deep brain stimulation of the basal ganglia in order to perform Gamma Knife ablations. Even then, this procedure should be reserved for those patients who refuse traditional open surgery or who have medical contraindications.


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Need an appointment? Request one online 24 hours/day, 7 days/week or call 800-789-PENN (7366) to speak to a referral counselor.

Gamma Knife and Leksell Gamma Knife are U.S. federally registered trademarks of Elekta Instrument S.A., Geneva, Switzerland. Photo credits: Susan Pardys, Elekta, Inc.

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