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Updated: Jun 29, 2025

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Deep Brain Stimulation for Orthostatic Tremor: An Observational Study.

Wietske A Babeliowsky1, Maarten Bot2, Wouter V Potters1

  • 1Neurology and Clinical Neurophysiology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands.

Movement Disorders Clinical Practice
|April 8, 2024
PubMed
Summary

Deep brain stimulation (DBS) targeting the Vim and DRT improved standing time for severe orthostatic tremor (OT) patients. While side effects occurred, long-term quality of life improved for most patients.

Keywords:
deep brain stimulationdentatorubrothalamic tractorthostatic tremorstanding timeventral intermediate nucleus of the thalamus

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Area of Science:

  • Neurology
  • Neurosurgery
  • Movement Disorders

Background:

  • Primary orthostatic tremor (OT) significantly impacts quality of life.
  • Deep brain stimulation (DBS) of the thalamic ventral intermediate nucleus (Vim) shows limited treatment data for OT.
  • A single trajectory targeting both Vim and the dentatorubrothalamic tract (DRT) is utilized, similar to essential tremor treatments.

Purpose of the Study:

  • To assess the long-term efficacy of Vim/DRT-DBS in improving standing time and Quality of Life (QoL) for OT patients.
  • To correlate stimulation of Vim, DRT, medial lemniscus (ML), and pyramidal tract (PT) with clinical outcomes and side effects.

Main Methods:

  • Nine patients with severe OT underwent bilateral Vim/DRT-DBS.
  • Primary outcome was standing time; secondary outcomes included QoL, neurophysiological measures, and side effects up to 56 months.
  • Volume of tissue activated (VTA) was analyzed in relation to outcomes.

Main Results:

  • Average standing time increased significantly from 41s to 109s after 18 months in 7/9 patients.
  • VTA overlapped with DRT in 6/7 patients and ML/PT in 6/7 patients.
  • QoL initially worsened but improved long-term, though remaining below normal; most patients reported positive effects despite side effects potentially linked to ML/PT stimulation.

Conclusions:

  • Vim/DRT-DBS effectively improves standing time in severe OT.
  • Side effects may be associated with medial lemniscus and pyramidal tract stimulation.
  • Long-term follow-up indicates potential for sustained benefit in QoL for OT patients treated with Vim/DRT-DBS.