Editing Tremor (section)

===Surgery===
Surgical intervention such as thalamotomy and deep brain stimulation may ease certain tremors. These surgeries are usually performed only when the tremor is severe and does not respond to drugs, and further evidence is required to determine the best course of treatment for any individual patient.<ref>{{Cite journal |last1=Kremer |first1=Naomi I. |last2=Pauwels |first2=Rik W. J. |last3=Pozzi |first3=Nicolò G. |last4=Lange |first4=Florian |last5=Roothans |first5=Jonas |last6=Volkmann |first6=Jens |last7=Reich |first7=Martin M. |date=2021-08-05 |title=Deep Brain Stimulation for Tremor: Update on Long-Term Outcomes, Target Considerations and Future Directions |journal=Journal of Clinical Medicine |volume=10 |issue=16 |pages=3468 |doi=10.3390/jcm10163468 |issn=2077-0383 |pmc=8397098 |pmid=34441763 |doi-access=free }}</ref><ref>{{Cite web |title=Essential tremor - Diagnosis and treatment - Mayo Clinic |url=https://www.mayoclinic.org/diseases-conditions/essential-tremor/diagnosis-treatment/drc-20350539 |access-date=2023-12-22 |website=www.mayoclinic.org |language=en}}</ref><ref>{{Cite journal |last1=Hallett |first1=Mark |last2=Litvan |first2=Irene |last3=the Task Force on Surgery for Parkinson’s Disease |date=1999 |title=Evaluation of surgery for Parkinson's disease: A Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology |url=https://www.neurology.org/doi/10.1212/WNL.53.9.1910 |journal=Neurology |language=en |volume=53 |issue=9 |pages=1910–1921 |doi=10.1212/WNL.53.9.1910 |pmid=10599758 |s2cid=28442991 |issn=0028-3878|url-access=subscription }}</ref> Response to surgeries can be excellent, reducing some symptoms such as "tremors, stiffness, slowness, and dyskinesias" for patients with Parkinson's Disease.<ref>{{Cite web |date=2021-08-08 |title=Deep Brain Stimulation |url=https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/deep-brain-stimulation |access-date=2023-12-22 |website=www.hopkinsmedicine.org |language=en}}</ref> 

[[Thalamotomy]], involving the creation of lesions in the brain region called the thalamus, is quite effective in treating patients with essential, cerebellar, or Parkinsonian tremor. This in-hospital procedure is performed under local anesthesia, with the patient awake. After the patient's head is secured in a metal frame, the surgeon maps the patient's brain to locate the thalamus. A small hole is drilled through the skull and a temperature-controlled electrode is inserted into the thalamus. A low-frequency current is passed through the electrode to activate the tremor and to confirm proper placement. Once the site has been confirmed, the electrode is heated to create a temporary lesion. Testing is done to examine speech, language, coordination, and tremor activation, if any. If no problems occur, the probe is again heated to create a 3-mm permanent lesion. The probe, when cooled to body temperature, is withdrawn and the skull hole is covered. The lesion causes the tremor to permanently disappear without disrupting sensory or motor control.

[[Deep brain stimulation]] (DBS) uses implantable electrodes to send high-frequency electrical signals to the thalamus. The electrodes are implanted as described above. The patient uses a hand-held magnet to turn on and turn off a pulse generator that is surgically implanted under the skin. The electrical stimulation temporarily disables the tremor and can be "reversed", if necessary, by turning off the implanted electrode. Batteries in the generator last about 5 years and can be replaced surgically. DBS is currently used to treat parkinsonian tremor and essential tremor. It is also applied successfully for other rare causes of tremor.

The most common side effects of tremor surgery include [[dysarthria]] (problems with motor control of speech), temporary or permanent cognitive impairment (including visual and learning difficulties), and problems with balance.<ref>{{Cite web |title=Surgical Treatments for Essential Tremor: Essential Facts for Patients |url=https://www.movementdisorders.org/MDS/Resources/Patient-Education/Surgical-Treatments-for-Essential-Tremor.htm |access-date=2023-12-22 |website=www.movementdisorders.org}}</ref>