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

Jack Shen1, Luca Marsili1, Alok K Dwivedi2

  • 1Department of Neurology and Rehabilitation Medicine, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, OH, USA.

Cerebellum (London, England)
|September 9, 2022
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Summary

Head tremor (HT) presence does not impact postural instability after deep brain stimulation (DBS) for essential tremor (ET). This study found similar outcomes in patients with and without head tremor undergoing Vim nucleus DBS.

Keywords:
Deep brain stimulationEssential tremorFallsHead tremorPostural instability

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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.