Head tremor and DBS: questions and answers

After a successful operation in experienced hands, head tremor stops or is greatly reduced. In Prof. YILMAZ’s peer-reviewed series of 22 patients with rare tremor syndromes treated with double-target Vim+PSA DBS, the mean tremor reduction was 89% (range 50–100%), and 6 of 7 patients with isolated head tremor had a tremor score of 0 at 12 months, as rated blindly by two movement disorder specialists ^[1]. In our own case series of patients treated with DBS for head tremor, average improvement was 87%, and more than 70% of patients reached near-complete resolution (our case series; results vary).

At our center the stimulator is switched on the day after surgery. After a successful operation, head tremor usually stops almost as soon as stimulation begins; some centers wait about two weeks before the first switch-on.

Rarely, a slight tremor can appear in moments of strong emotion. We use specific settings for this, and double targeting gives more room to adjust; with them, at most a very mild tremor remains in such moments.

Speech problems were a known risk when only the Vim was targeted. With double-target Vim+PSA stimulation this risk is much reduced: in our experience the PSA is safer than the Vim with respect to speech, and because both targets are on the same electrode, stimulation can be moved away from a site that causes a problem. Temporary effects usually resolve with adjustment ^[1].

Some studies report that Vim-only stimulation can lose effect over years. Our longest-followed head tremor patient still has a tremor score of 0 six and a half years after double-target DBS; the score was 4 before surgery (our case series; results vary). If the effect lessens or the disease progresses, the second target is activated by reprogramming.

It shares the stimulation between two targets at lower intensity, which helps avoid numbness, speech and balance problems; it keeps a second target in reserve if the disease progresses; and it allows switching between the Vim and the PSA by reprogramming, without new surgery.

Stitches are removed on day 12, and you can shower three days later.

You can comb gently once the wounds are dry and dye your hair after one month.

After one month.

No. Everything is under the skin. Wounds are closed cosmetically, so scars are usually barely visible.

Yes. Head tremor is controlled by both sides of the brain, and these conditions tend to progress, so we treat both sides. One-sided surgery is considered only for a clearly one-sided dystonic tremor.

During electrode placement you are awake under local anesthesia so that test stimulation can be checked; MRI planning and implantation of the stimulator are done under general anesthesia.

DBS is an established operation performed worldwide for decades. Like any brain surgery it carries risks, including bleeding, infection and stimulation side effects, which are discussed with you in detail ^[1].

Age alone is not the deciding factor; overall health and the type of symptoms matter most. Every patient is assessed individually by the full team.

An all-inclusive DBS package at our center typically ranges between USD 30,000 and USD 45,000, depending on the package and the type of device selected. The final figure is confirmed after your evaluation.

About 10–14 days in the standard program, or 18 days in the extended package (6 days in hospital and 12 in a hotel).

Yes. He makes every candidacy decision personally and performs every operation, supported by a 25-member team.

Remote programming by secure video call is free for 3 to 5 years, depending on the package chosen; after that it remains available, without limit, for a fee.

Our international department supports patients in English, Arabic, Russian, Uzbek, Kyrgyz, Kazakh, Serbian, French and Turkish. Prof. YILMAZ consults in English and Arabic, and an interpreter stays with you during surgery.

No. An MRI helps if you already have one, but the online review can go ahead without it.

Yes. The stimulation can be switched off, and the system can be removed if ever necessary.