Secondary head tremor

Secondary head tremor is tremor caused by another identifiable condition — most often multiple sclerosis, a traumatic brain injury, a stroke or bleed, or a metabolic problem such as liver disease. Treating the cause comes first. When the tremor persists and is disabling, DBS can help selected patients, although results are generally less consistent than in essential tremor ^[1],[2].

Key facts

Secondary head tremor has an identifiable cause: multiple sclerosis, brain injury, stroke, liver disease or medicines.
Treating the cause comes first.
DBS helps selected patients when the condition is stable ^[1].
Results are more variable than in essential tremor.
In our series, all four post-traumatic Holmes tremor patients reached a tremor score of 0 ^[2].

Main causes

Multiple sclerosis — lesions in the cerebellar pathways
Traumatic brain injury
Stroke, bleeding or tumors in the midbrain, thalamus or cerebellum — see Holmes tremor
Metabolic causes — our published series included a patient with tremor due to liver disease (hepatic encephalopathy), whose tremor score improved by 75% ^[2]
Medicines — some drugs cause tremor; your doctor reviews the medication list

How it is assessed

Brain MRI to define the lesion
Whether the underlying condition is stable — for example, multiple sclerosis without recent relapses
Strength, coordination and walking, because tremor control helps most when enough function remains
Blood tests for metabolic causes

When DBS is considered

The underlying condition should be stable, and the tremor should be the main disabling problem. Because these tremors are often coarse and involve the shoulder and trunk, the PSA is particularly useful, and combining it with the Vim gives more programming options ^[2]. See DBS for Holmes and secondary tremor.

Realistic expectations

Secondary tremors vary. In our series, most patients improved substantially, but two patients with tremor after cerebellar injury improved by half rather than completely ^[2]. Your own prospects are discussed after your videos and MRI have been reviewed.

Your surgeon

Prof. Atilla YILMAZ, MD

Every operation is performed personally by Prof. YILMAZ, a stereotactic and functional neurosurgeon who has carried out 1,200+ neuromodulation procedures, including 800+ DBS surgeries, for patients from 60+ countries. He is the first author of the published double-target Vim+PSA series for rare tremor syndromes ^[2].

President, Middle-Eastern Society for Stereotactic and Functional Neurosurgery (MSSFN); Board of Directors, WSSFN and International Neuromodulation Society
Proctor for Medtronic, Abbott and Boston Scientific — the three leading DBS manufacturers appoint him to train other neurosurgeons on their systems
40+ neurosurgeons trained from 30 countries; first-ever DBS surgeries performed in six countries
Trained at the University of Florida (observership with Prof. Okun and Prof. Foote) and Umeå University Hospital, Sweden

Full profile and credentials

Frequently asked questions

Can DBS help tremor from multiple sclerosis?

In selected patients, yes. Our published series included patients with tremor from multiple sclerosis treated with double-target DBS ^[2]. Suitability depends on how active the multiple sclerosis is and on the patient’s overall condition.

Can liver disease cause tremor?

Yes. Severe liver disease can affect the brain and cause tremor-like movements. Our series included the first published case of DBS for tremor caused by hepatic encephalopathy ^[2].

Is DBS safe if I have multiple sclerosis?

It can be, in selected patients whose disease is stable. The risks and expected benefit are assessed individually.

Sources

Putzke JD, Uitti RJ, Obwegeser AA, Wszolek ZK, Wharen RE. Bilateral thalamic deep brain stimulation: midline tremor control. J Neurol Neurosurg Psychiatry 2005;76(5):684–690. pmc.ncbi.nlm.nih.gov/articles/PMC1739619/
Yilmaz A, Eray HA, Cakir M, Ceylan M, Blomstedt P. Deep Brain Stimulation with Double Targeting of the VIM and PSA for the Treatment of Rare Tremor Syndromes. Stereotact Funct Neurosurg 2024;102:224–239. DOI 10.1159/000539162. pubmed.ncbi.nlm.nih.gov/38934181/