Reduction in DBS frequency improves balance difficulties after thalamic DBS for essential tremor

Area of Science:

• Neurology
• Neurosurgery

Background:

• Essential tremor (ET) often involves cerebellar features like gait and balance impairment.
• Deep brain stimulation (DBS) of the thalamus (VIM nucleus) effectively treats ET tremor, but its impact on balance is debated.

Purpose of the Study:

• To investigate the effects of modifying DBS frequency on balance and disequilibrium in ET patients.
• To review existing literature on neurostimulation's impact on balance in ET.

Main Methods:

• Four ET patients with post-DBS disequilibrium had their DBS frequency reduced (10-20Hz intervals) to the lowest effective tremor-control settings.
• Balance and disequilibrium were assessed immediately and at 4 weeks post-frequency adjustment.

Main Results:

• All patients reported subjective and objective improvements in balance and gait.
• No significant difference in tremor control was observed after DBS frequency reduction.
• Results suggest high-frequency DBS may contribute to disequilibrium in ET.

Conclusions:

• Lowering DBS frequency may improve balance in ET patients without compromising tremor control.
• Further research is needed to understand the relationship between DBS parameters and cerebellar function in ET.