The diagnosis of essential tremor is difficult and often delayed due, in part, to the similarities
with Parkinson’s disease.
Essential tremor has a strong impact on different aspects of daily life and results in
a significant deterioration in the quality of life. There is no cure for tremor
essential.
Non-specific drug treatments can be started, but they are found to be
ineffective or poorly tolerated for nearly half of patients. Surgical, invasive,
may be offered to some patients.
Other drug treatments, benzodiazepines, other anticonvulsants, as well as botulinum toxin can be prescribed as a second line. However, drug treatments are only effective in 30 to 50% of patients. In addition, they are poorly tolerated in 13% in case of chronic administration.
In refractory patients with severe essential tremor, surgical treatment may be considered. Deep brain stimulation (DBS) of the ventral intermediate nucleus (Vim) of the thalamus (using a microelectrode implanted in the brain) is currently the only validated surgical treatment for the treatment of severe essential tremor.
Due to its invasive nature, DBS can only be offered to a small number of patients who meet strict selective criteria, and is associated with a significant risk of adverse effects (intracranial hemorrhage, infections). In addition, the therapeutic effects appear only after a certain delay, the time to adjust the device optimally.
Gamma Knife radiosurgery, less invasive, represents an alternative in case of contraindication to DBS. However, it has not yet been the subject of any medical or regulatory consensus and does not have specific care in France.
This surgery consists of a very partial radiation of a very localized area of the brain, defined thanks to stereotaxis, a 3-dimensional coordinate system that makes it possible to locate in a
very precise the different structures of the brain. But, in addition to the undesirable effects associated with ionizing radiation, the effect of this radiosurgery does not appear until several months, or even a year, after the procedure.
In this regard, let us recall that ExAblate Neuro is a medical device developed by the company Insightec which offers a therapeutic alternative to patients with severe essential tremor and refractory to drug treatments (approximately 300 to 800 people per year in France). This new technology allows thermal ablation of an area of the brain of less than one millimeter, corresponding to the ventral intermediate nucleus (Vim) of the thalamus. It is already used in some countries such as the USA, Italy, Spain or Japan.
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