[Essential Tremor That is Difficult to Improve with Standard Medical Treatment-Suppression: Surgical Treatment of Tremor].

Drug-refractory essential tremors, especially those in the upper extremities, may benefit from surgical treatment. Currently, three main treatment methods are available: deep brain stimulation (DBS), radiofrequency coagulation (RF), and magnetic resonance -guided focused ultrasound surgery (MRgFUS). DBS is a device-based therapy, and its effects are reversible, whereas RF and FUS create irreversible coagulation lesions. DBS and RF require the direct puncturing of the target, whereas FUS focuses ultrasound from extracranial sources. The primary target is the ventralis intermedius of the thalamus (Vim); however, the posterior subthalamic area (PSA) is also reportedly an effective target site. In this article, we will summarize the features of the three treatments for essential tremors, and discuss the treatment strategies and methods for each symptom.