Does Head Tremor Predict Postural Instability After Bilateral Thalamic Stimulation in Essential Tremor?

Area of Science:

• Neurology
• Neurosurgery

Background:

• Essential tremor (ET) is a neurological disorder often treated with deep brain stimulation (DBS).
• Head tremor (HT) is a common ET symptom, potentially linked to cerebellar dysfunction.
• Ventral intermediate (Vim) nucleus DBS is effective for ET but can cause side effects like postural instability.

Purpose of the Study:

• To investigate if head tremor influences the risk of postural instability after Vim DBS in ET patients.
• To compare post-operative postural instability between ET patients with and without head tremor.

Main Methods:

• Retrospective cohort study analyzing 30 patients with ET who underwent bilateral Vim DBS.
• Patients were categorized into head tremor (HT) and no head tremor (nHT) groups.
• Postural instability assessed using Wilcoxon rank sum test and time-to-event analysis with Cox regression.

Main Results:

• No significant difference in postural instability at 24 months post-Vim DBS between HT (64%) and nHT (69%) groups (p=0.82).
• Adjusted hazard ratio for postural instability was 0.82 (p=0.69), indicating no increased risk associated with HT.
• The presence or absence of head tremor did not affect the likelihood of developing postural instability.

Conclusions:

• Head tremor is not a predictor of postural instability following Vim DBS in essential tremor.
• Vim DBS remains a viable treatment for ET, irrespective of head tremor presence.
• Further research may explore other factors influencing DBS-related side effects in ET.