Thalamic Deep Brain Stimulation in Essential Tremor Plus Is as Effective as in Essential Tremor

Area of Science:

• Neurology
• Neurosurgery

Background:

• Essential tremor (ET) is classified into ET and ET-plus (ET-p), characterized by additional neurological signs.
• Deep brain stimulation (DBS) is a recognized treatment for medication-refractory ET.
• Limited research exists on DBS efficacy specifically in the ET-p subgroup.

Purpose of the Study:

• To evaluate the effectiveness of DBS in patients with ET-p compared to those with ET.
• To analyze differences in tremor suppression, stimulation parameters, and electrode contact location between ET and ET-p groups.

Main Methods:

• Retrospective analysis of 44 patients with medication-refractory ET who underwent thalamic/subthalamic DBS.
• Patients were classified into ET and ET-p groups postoperatively.
• Tremor severity was assessed using the Fahn-Tolosa-Marin tremor rating scale (TRS) with stimulation ON versus OFF/baseline.

Main Results:

• ET-p patients presented with higher baseline tremor severity (TRS scores).
• DBS achieved comparable tremor suppression in both ET and ET-p groups.
• ET-p patients required higher stimulation parameters for tremor reduction.
• Active electrode contacts were located more dorsally in the ET-p group.

Conclusions:

• DBS is an effective treatment for tremor reduction in ET-p, similar to ET.
• Higher stimulation parameters and a more dorsal contact location may be characteristic of DBS in ET-p.
• Further prospective studies are recommended to elucidate DBS outcomes in ET-p.