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Differentiating Postural and Kinetic Tremor Responses to Deep Brain Stimulation in Essential Tremor.
Rebecca D Butler1, Annemarie K Brinda1, Madeline Blumenfeld1
1Department of Biomedical Engineering, University of Minnesota, Minneapolis, Minnesota, USA.
Movement Disorders Clinical Practice
|November 7, 2024
Summary
Deep brain stimulation (DBS) for Essential Tremor (ET) significantly improved postural tremor but showed limited effects on kinetic tremor. Individual variability in tremor response highlights the need for tailored DBS programming strategies.
Area of Science:
- Neuroscience
- Neurology
- Biomedical Engineering
Background:
- Deep brain stimulation (DBS) targeting the ventral intermediate nucleus (VIM) or posterior subthalamic area (PSA) is used for Essential Tremor (ET).
- Previous research suggests DBS may be more effective for postural tremor than kinetic tremor.
Purpose of the Study:
- To precisely quantify the onset/offset dynamics and steady-state effects of VIM/PSA-DBS on postural and kinetic tremor in ET patients.
- To compare the efficacy of DBS in suppressing postural versus kinetic tremor.
Main Methods:
- 11 participants with ET underwent assessment of tremor using wireless inertial measurement units.
- Tremor data were collected during postural hold and kinetic tasks with DBS on and off.
- Clinician-optimized DBS settings were used, with wash-in and wash-out periods analyzed.
Main Results:
- Kinetic tremor exhibited significantly higher baseline amplitude, standard deviation, and frequency than postural tremor.
- DBS demonstrated a robust acute effect on postural tremor (54% decrease), with rapid suppression.
- Population-level improvement in kinetic tremor was non-significant (34% decrease), with considerable individual variability observed.
Conclusions:
- DBS programming for VIM/PSA should account for individual variability in temporal dynamics and effect sizes for postural versus kinetic tremor.
- Enhanced targeting and programming strategies may be required to achieve equivalent suppression of both tremor types.
