Perception of neurosurgery among surgical patients with essential tremor: A qualitative mixed methods study

Abstract

Background: There is a dearth of evidence on knowledge and perceptions of procedures among patients with essential tremor (ET). The objective of this study was to utilize a mixed methods design incorporating in-depth individual interviews to investigate the perception of procedures among patients with ET who underwent surgical intervention. Methods: Semi-structured, in-depth individual interviews paired with survey questionnaires were conducted among participants with ET who had a prior surgical procedure for the disorder. Thematic analysis of qualitative data was conducted using an approach based on grounded theory methodology. Results: Of the 20 patients interviewed, nine patients (45 %) had undergone magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy, nine patients (45 %) had undergone deep brain stimulation (DBS) implantation, and two patients (10 %) had undergone both DBS implantation and MRgFUS thalamotomy. In ranking factors from most to least important in deciding which type of surgery to undergo, patients most frequently selected safety as the most important factor (9/20, 45 %). Hair shave required was most frequently selected as the least important factor (14/20, 70 %). Seven patients (35 %) reported having zero or minimal knowledge of the risks and benefits of either MRgFUS thalamotomy or DBS before their surgery. Patients discussed their surgical outcomes including adverse effects of surgery. Conclusions: In deciding which type of surgery to undergo for tremor, participants discussed the role of safety, perceived invasiveness, and follow-up care required. Participants reflected on the life-changing benefits of tremor control but also discussed detrimental adverse effects such as dysarthria and gait instability following surgery.

Keywords

• Essential tremor
• Neurosurgery
• Qualitative research