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Updated: May 10, 2026
MRI-guided Focused Ultrasound Thalamotomy for Patients with Medically-refractory Essential Tremor
Published on: December 13, 2017
Effects of low-frequency thalamic deep brain stimulation in essential tremor patients
David J Pedrosa1, Michelle Auth, Carsten Eggers
1Department of Neurology, University Hospital Cologne, Cologne, Germany.
Background:
Essential tremor (ET) patients may present with postural and/or intentional tremor. But despite high-frequency thalamic deep brain stimulation (DBS) effectively suppressing both, the emergence of intentional tremor has been attributed to a higher extent to cerebellar dysfunction. Therefore, we hypothesized thalamic 10 Hz-stimulation, which is known to worsen motor functions, having more impact on intentional tremor than on postural tremor.
Methods:
In sixteen ET-patients with bilateral thalamic-DBS, tremor rating scale (TRS) and ultrasound-based tremor-amplitude measurements were analyzed by sequentially applying three DBS-settings in a randomized order: i) low-frequency stimulation (LFS), ii) DBS being turned off (DBS-OFF) and iii) high-frequency stimulation (HFS). Repeated measures analyses of variance for TRS and for the quotients of tremor-amplitudes during DBS-OFF and LFS for intentional (q(int)) and postural tasks (q(post)) were calculated. Finally, electrode localization and the abovementioned quotients were put into relation by Pearson's correlation coefficient.
Results:
HFS reduced TRS significantly compared to DBS-OFF and LFS (ps<.001), while the latter two also differed significantly with TRS being the worst during LFS (p<.05). Additionally, intentional tremor-amplitude appeared to be strongly influenced by LFS than postural tremor-amplitude (p<.05). Furthermore, a lower placement of the electrodes caused worse intentional tremor-amplitude during LFS (r=.517, p>.05), while postural tremor-amplitude was unrelated to electrode localization (ps<.05).
Conclusions:
During LFS in ET-patients, there is a more severe exacerbation of intentional tremor compared to postural tremor. Possibly, there are two different mechanisms responsible for both tremor entities, making more refined stimulation regimes feasible in the future.
