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The New England Journal of Medicine -- February 17, 2000 -- Vol. 342, No. 7 A Comparison of Continuous Thalamic Stimulation and Thalamotomy for Suppression of Severe Tremor P. Richard Schuurman, D. Andries Bosch, Patrick M.M. Bossuyt, Gouke J. Bonsel, Eus J.W. van Someren, Rob M.A. de Bie, Maruschka P. Merkus, Johannes D. Speelman Background: Deep-brain stimulation through an electrode implanted in the thalamus was developed as an alternative to thalamotomy for the treatment of drug-resistant tremor. Stimulation is thought to be as effective as thalamotomy but to have fewer complications. We examined the effects of these two procedures on the functional abilities of patients with drug-resistant tremor due to Parkinson's disease, essential tremor, or multiple sclerosis. Methods: Sixty-eight patients (45 with Parkinson's disease, 13 with essential tremor, and 10 with multiple sclerosis) were randomly assigned to undergo thalamotomy or thalamic stimulation. The primary outcome measure was the change in functional abilities six months after surgery, as measured by the Frenchay Activities Index. Scores for this index can range from 0 to 60, with higher scores indicating better function. Secondary outcome measures were the severity of tremor, the number of adverse effects, and patients' assessment of the outcome. Results: Functional status improved more in the thalamic-stimulation group than in the thalamotomy group, as indicated by increases in the score for the Frenchay Activities Index (from 31.4 to 36.3 and from 32.0 to 32.5, respectively; difference between groups, 4.4 points; 95 percent confidence interval, 2.0 to 6.9). After adjustment for base-line characteristics, multivariate analysis also showed that the thalamic-stimulation group had greater improvement (difference between groups, 5.1 points; 95 percent confidence interval, 2.3 to 7.9). Tremor was suppressed completely or almost completely in 27 of 34 patients in the thalamotomy group and in 30 of 33 patients in the thalamic-stimulation group. One patient in the thalamic-stimulation group died perioperatively after an intracerebral hemorrhage. With the exception of this incident, thalamic stimulation was associated with significantly fewer adverse effects than thalamotomy. Functional status was reported as improved by 8 patients in the thalamotomy group, as compared with 18 patients in the thalamic-stimulation group (P=0.01). Conclusions: Thalamic stimulation and thalamotomy are equally effective for the suppression of drug-resistant tremor, but thalamic stimulation has fewer adverse effects and results in a greater improvement in function. (N Engl J Med 2000;342:461-8.) Source Information >From the Departments of Neurology (P.R.S., R.M.A.B., J.D.S.), Neurosurgery (P.R.S., D.A.B.), and Clinical Epidemiology and Biostatistics (P.M.M.B., G.J.B., M.P.M.), Academic Medical Center; and the Netherlands Institute for Brain Research (E.J.W.S.) -- both in Amsterdam. Address reprint requests to Dr. Speelman at the Department of Neurology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands, or at [log in to unmask] See also the Related Editorial Copyright © 2000 by the Massachusetts Medical Society. All rights reserved.