A team headed Dr. Pankaj Agarwal, Movement Disorders Neurologist and Dr. Naren Nayak, Functional Neurosurgeon at Global Hospital, Mumbai successfully treated a 68-year-old woman with severe Essential Tremor (ET), a neurological condition that causes involuntary and rhythmic shaking (tremor) of the hands, head, and voice. She underwent DBS (Deep Brain Stimulation), a surgical procedure involving electrical stimulation of the certain brain cells that control tremor.
Mrs. Sulabha Tele, a housewife from Pune was suffering from very severe hand tremors for 8 years. She had violent shaking of her hands whenever she tried to pick up an object. Over the last few years, she was slowly unable to do her daily routine activities like eating, drinking, holding an object by herself. As a result, she became dependent on her family members to feed her. The family met several neurologists, and treatment with a combination of medicines prescribed resulted in the only minimal and temporary relief of her hand tremors.
Dr. Pankaj Agarwal, Senior Consultant – Neurology, Head – Movement Disorders Clinic and In-charge – DBS program, Global Hospital, Mumbai, said, “This patient had a severe form of Essential Tremor (ET). ET is a common neurological condition that causes uncontrollable shaking of both their hands and also the head and voice. Its onset is usually after the age of 60, but it can occur at a younger age as well. Its cause is unknown but involves abnormal rhythmic oscillatory activity in certain brain networks that control movement.”
“Although ET closely resembles Parkinson’s disease (PD), unlike in PD, the tremor in ET most often occurs on activity (rather than when the hands are resting) and therefore interferes with daily activities typically holding a cup, or pouring liquids, or writing. Medicines can help patients with ET to an extent. But they may be ineffective in few patients like her. Given the severe, intractable and extremely disabling nature of her tremor, she was offered thalamic Deep Brain Stimulation (DBS)” explained Dr. Agarwal.
DBS of certain brain regions, such as the VIM nucleus of thalamus is very effective for ET, and DBS is the most commonly performed surgical treatment for ET. In this, thin metal wires are placed in the brain; these wires send electrical pulses to the brain to help control some motor symptoms. It works best to lessen motor symptoms of stiffness, slowness, and tremor. She underwent the 4-hour long awake surgery. During the surgery, doctors asked her to mimic using a spoon and write with a pen on the operating table, and saw immediate relief of handshaking as the wire was carefully placed in the brain target.”
“The patient had immediate and complete relief from tremor. The next day after surgery, she was able to eat the first morsel of food with her own hands, and drink water without spilling, and shaking, after 3 years. DBS can be life-changing for tremor, with even complete relief possible in some cases like this one.” Said Dr. Agarwal.