Deep Brain Stimulation and Tremor

Abstract

Summary: Deep brain stimulation (DBS) has been used to treat various tremor disorders for several decades. Medicationresistant, disabling essential tremor (ET) is the most common tremor disorder treated with DBS. The treatment has been consistently reported to result in significant benefit in upper extremity, as well as head and voice tremor, all of which were improved more dramatically with bilateral procedures. These benefits have been demonstrated to be sustained for up to 7 years. DBS has also been shown to be beneficial for the tremor associated with multiple sclerosis and post-traumatic tremor; however, fewer cases have been reported and the benefit is less consistent, less dramatic, and more transient than that seen with ET. The ventral intermediate nucleus of the thalamus is the most common DBS target for tremor disorders, but more recent studies have demonstrated benefits in tremor from DBS of the subthalamic area, primarily the zona incerta. Surgical complications are relatively uncommon and are generally less frequent than those seen with thalamotomy. Stimulation-related effects are usually mild and resolve with adjustment of stimulation parameters. DBS is thus a relatively safe and effective treatment for tremor disorders, particularly for medication-resistant, disabling ET, but may also have some role in medicationresistant, disabling tremor associated with multiple sclerosis and traumatic head injury.

Long-Term Effects of Deep Brain Stimulation for Essential Tremor with Subjective and Objective Quantification via Mailed-In Questionnaires

“…This functional disability is due not only to the physical limitations the tremor itself induces but also to the social embarrassment and withdrawal these patients suffer. The safety and efficacy of stimulation of the VIM are well documented in the literature [20,21,22,23] and, although thalamotomy and DBS may provide comparable improvement of the condition, adverse effects (such as dysarthria, cognitive deterioration and gait disturbances) are generally more common with ablative procedures [24]. Our data corroborates that VIM DBS improves tremor and performance in a variety of daily living even several years after implantation.…”

The dynamics of finger tremor in multiple sclerosis is affected by whole body position

“…The emergence of increased bilateral coupling within the MS group may indicate that this disease process affects the neurological structures underlying tremorgenesis. Given that approximately 80% of MS patients have lesions within the brainstem or cerebellum [17], and these same structures are also believed to play a role in tremor production [36,37], it is possible that the progressive decline in function within these central neural sites could be a factor in the development of increased coupling.…”

“…The majority of treatment options discussed in the literature specific to MS include neurosurgery [12,45] and brain stimulation techniques in advanced cases [17,46,47]. However, there is evidence that less invasive treatment such as exercise could mitigate tremor abnormalities in other populations, as resistance training has been found to decrease tremor amplitude in older adults [48,49] and in persons with ET [50].…”

“…Enhanced tremor is a common manifestation of this central nervous system damage, being reported in 25-60% of MS cases, with the two most prevalent forms being intention tremor and postural tremor [15][16][17][18]. Although tremor is a prevalent motor symptom for a sizable proportion of individuals with MS, the majority of research has been restricted to simply assessing changes in amplitude [19,20].…”

Clinical Spectrum of Movement Disorders after Stroke in Childhood and Adulthood

“…Improvement has been reported with botulinum toxin A injections, in particular in palatal and writing tremor [18]. In severe cases, functional neurosurgery may be useful [30]. …”