Essential tremor patient regains independence following surgery

Public release date: 26-Mar-2012 [ | E-mail | Share ]

Contact: Megan McCann memccann@nmh.org 312-926-5900 Northwestern Memorial Hospital

CHICAGO For nearly 30 years, Tom Rogers' left hand would shake when he tried to use it, making even simple tasks such as drinking a glass of water, writing a check, or making a sandwich challenging. The tremor eventually became so disruptive that he lost use of his dominant hand. Rogers sought care and learned that his tremor was a symptom of Parkinson's disease, yet felt he was suffering from something different.

"I was familiar with Parkinson's because my father had it and I knew this wasn't the same," said Rogers, a 66-year-old retired truck driver who resides in Oswego, Ill. "It was exactly the opposite of my dad's tremor which would start when he was still or relaxed. My hand would shake when I had something in it or tried to use it."

Also convinced that her husband was suffering from something other than Parkinson's, Pam Rogers began searching the internet. Through her research the couple learned about another movement disorder called essential tremor and found their way to Northwestern's Parkinson's Disease and Movement Disorders Center. Northwestern Medicine movement disorder specialists diagnosed Rogers with essential tremor, a neurological disorder that causes shaking in the hands, head, voice and occasionally the legs and trunk. An estimated 10 million Americans have essential tremor making it eight times more prevalent than Parkinson's, yet the two are often confused.

"Essential tremor is not a life-threatening disease, but it worsens over time and can be very debilitating," explained Joshua Rosenow, MD, director of functional neurosurgery at Northwestern Memorial Hospital and associate professor of neurosurgery at Northwestern University Feinberg School of Medicine. "Severe cases can profoundly impact a person's quality of life and limit the ability to function independently. As the condition progresses, it becomes more challenging for these patients to eat, feed themselves, write or drive. Some even become too frustrated or embarrassed to go out in public because of their tremor."

The disorder can be treated with medications, but many do not adequately control the tremor or cause negative side effects that outweigh the benefit. Patients are encouraged to eliminate any stimuli that increase their tremor, such as caffeine or life stress. When those treatments fail, deep brain stimulation (DBS) surgery is an option for some patients.

"Essential tremor is a vastly undertreated disorder, but DBS is tremendously effective, often much more so than medications," explained Rosenow. "DBS involves implanting small electrodes into very specific region deep in the brain to deliver continuous high frequency electrical impulses. Each electrode is connected to an extension wire that runs under the skin down to the chest where a battery pack is implanted. This pack acts as a 'pacemaker' for the brain and helps control the tremor."

After medication failed to control his tremor, Rogers made the decision to have DBS surgery. "It got to the point where I couldn't even sign my own name with my left hand and it was beginning to affect my right hand as well," said Rogers. "I knew if I ignored it, eventually I wouldn't be able to function on my own."

During DBS, the surgeon first plans the surgery by mapping out the best path for the electrode using detailed 3-D images of the brain. The patient is awake for part of the surgery and becomes a key member of the team as they map out the correct location for the electrode. Local anesthetic is given so that no discomfort is felt.

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Essential tremor patient regains independence following surgery