Unilateral thalamotomy is known to virtually cure most forms of tremors and dystonia of focal origin…


Thalamotomy includes formation of lesions in VIM thalamic nucleus in the brain and is quite effective in treating patients with crucial, cerebellar or Parkinsonian tremor.

  • 80-90% decrease in limb tremor (with most complete or almost complete reduction in tremor)
  • Overall distresses are much more dramatic then medications – Bilateral lesioning generally not done b/c of side effects.
  • Advantage over DBS that no hardware, no programming.

Thalamic Deep Brain Stimulation (DBS) uses implantable electrodes to send high-frequency electrical signals to the thalamus.

  • 60-90% improvement in tremor on average
  • Fewer side effects then thalamotomy
  • May have benefit for bilateral implantation for voice and head tremor.

The most favored thalamic target is Vim (Ventrointermedius) nucleus of thalamus as defined by Hassler.  Vim is a strip of thalamic nucleus situated just anterior to the sensory thalamus. The dimensions of the Vim nucleus are 3 to 4 mm rostrocaudally, about 10 mm in width, and about 10 mm in height.


The axial map of the thalamus showing the location of thalamic target (marked in red).