Tremor reduction by microinjection of lidocaine during stereotactic surgery

We report our experience with lidocaine microinjection into the thalamus in 10 patients undergoing stereotactic thalamotomy for the treatment of Parkinsonian or non-Parkinsonian tremor. 18 injection sites in 4 patients with Parkinson's disease and 22 sites in 6 patients with other forms of tremor have been compared with respect to the effect of microstimulation. In over two thirds of cases the test microinjection replicated the effects of microstimulation. Long term follow up will be required to determine whether lesions made on the basis of lidocaine induced tremor suppression will result in a lower rate of tremor recurrence than those based on stimulation induced tremor suppression. In those patients in whom stimulation induced tremor suppression occurs but tremor arrest cannot be produced with lidocaine microinjection, chronic thalamic stimulation may be an alternative for the long term control of tremor in these patients.