Gamma Knife Procedure Reduces Tremors

Gamma Knife^® surgery is a painless computer-guided treatment that delivers highly focused radiation to tumors and lesions in the brain. It is used to treat a variety of things, including tremors, something for which 89-year-old Phillip Schwenz is extremely grateful.

Mr. Schwenz first noticed a tremor in his hand when he was about 16. But the tremor didn’t bother him much until he was in his mid-30s.

“It started manifesting in different ways. I had difficulty when working on the car, or with tools around the house. I went to my family doctor, who put a name to it – essential tremor,” says Mr. Schwenz. “I went to a neurologist, who prescribed a small dose of medicine used for seizures. That seemed to help.”

“Patients usually complain more about the tremors in their dominant hand, because they depend more on that hand,” says Michal Gostkowski, DO, a Cleveland Clinic neurologist and movement disorders specialist who first saw Mr. Schwenz in 2014. “His case is very typical, and medication helped reduce the symptoms for many years.”

The cause of essential tremor is unknown, but it can be hereditary. Mr. Schwenz has a strong history on his father’s side of the family.  

When Mr. Schwenz first saw Dr. Gostkowski, he had difficulty holding a cup of coffee, made a mess when eating, and couldn’t take care of simple repairs at home. He wanted to get the tremors under control.

Dr. Gostkowski enrolled Mr. Schwenz in a clinical trial involving Botox injections into his right forearm. “It helped for a while, but after two or three visits, I noticed a loss of strength. I felt the loss of muscle was worse than the good effects of the Botox,” says Mr. Schwenz.

Dr. Gostkowski also evaluated Mr. Schwenz for deep brain stimulation surgery (DBS) and high intensity focused ultrasound (HIFU).

DBS involves an implanted device that delivers an electrical current directly to areas of the brain, helping to improve how well those parts work. HIFU uses very high-intensity and highly focused sound waves that interact with targeted tissues to modify or destroy them.  

“Mr. Schwenz felt DBS would be difficult, and he wasn’t a candidate for HIFU because the due to the density of his skull – it was too thin,” says Dr. Gostkowski, who then offered the option of Gamma Knife surgery.

“It’s an older technique, but it works. Gamma Knife uses radiation where HIFU uses ultrasound to damage a very specific area in the brain. With HIFU, we’re able to find the spot in the brain, test it, see what makes a difference, then go back and make changes if needed. With the Gamma Knife, we have just one chance to make that difference,” he explains.

In April 2022, Mr. Schwenz underwent Gamma Knife surgery. Because the procedure damages tissue, it takes a while to see results.

“After six weeks, I noticed a 50% improvement in the tremor in my right hand, and after six months, the tremor was almost entirely gone,” says Mr. Schwenz, who is now able to hold his cup of coffee easily with his right hand and take care of small repairs around the house.

The Gamma Knife procedure required Mr. Schwenz to be at Cleveland Clinic for just one day. “It’s a very noninvasive treatment that provided him with life-changing results,” says Dr. Gostkowski.