Unilateral thalamotomy improves contralateral tremor [3]. Bilateral thalamotomy is rarely performed, as it can cause cognitive and gait disturbances [4].

In contrast to ablative surgery, deep brain stimulation (DBS) is reversible and potentially adjustable. The goal of DBS is to render a target non-functional by stimulating it at high frequency. Unilateral thalamic DBS improves contralateral hand tremor. It is used mainly for essential tremor [5,6]. Bilateral thalamic DBS can improve tremor in both hands and in the head. Side effects may include serious cognitive and gait disturbances. The stimulation-related adverse effects of bilateral thalamic DBS may be more reversible than the adverse effects of bilateral thalamotomies.

DBS has several advantages over ablative surgery. It causes less brain trauma, is reversible and can be modified in terms of which of the four stimulation sites is active. Adjustments to the intensity, duration and frequency of the stimulation can also be made. The procedure can also be performed bilaterally. Side effects of the surgical procedure include brain hemorrhage, infarct, seizures and death. Adverse effects exclusive to DBS include the hours required to adjust the settings, lead damage or failure, the need to replace batteries after 3-5 years, the potential for infection and erosion of the device through the skin. Worsening dyski-nesia (in the case of STN stimulation), pares-thesias and subtle cognitive and mood changes have also been reported. Some of these side effects may be reversible by adjusting stimulation parameters, but hardware failure requires removal or replacement of parts or the entire device.

Brain Blaster

Brain Blaster

Have you ever been envious of people who seem to have no end of clever ideas, who are able to think quickly in any situation, or who seem to have flawless memories? Could it be that they're just born smarter or quicker than the rest of us? Or are there some secrets that they might know that we don't?

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