Subthalamic Nucleus Deep Brain Stimulation Improves Kinetic Tremor in Parkinson's Disease

Although resting tremor is a characteristic feature of Parkinson's disease (PD), many patients also suffer from action tremor. Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is effective in reducing motor symptoms. However, it is unclear to what extent STN-DBS improves action tremor in PD, particularly kinetic tremor.

Evaluate the effectiveness of STN-DBS on resting, postural, and kinetic tremor, with particular focus on kinetic tremor.

PD patients treated with bilateral STN-DBS were included. Patients with a score of ≥1 for tremor subtypes in either stimulation condition were included for tremor subtype analyses. The Movement Disorders Society - Unified Parkinson's Disease Rating Scale (MDS-UPDRS) was administered OFF-medication, for both the OFF- and ON-stimulation condition, 6-12 months post-surgery. Wilcoxon signed-rank tests were used and effect sizes calculated. In addition, sensitivity analyses and a systematic literature review was performed.

422 patients were included. For tremor subtype analyses, 251 patients were included for resting tremor amplitude, 270 for resting tremor constancy, 215 for postural tremor and 144 for kinetic tremor. DBS significantly improved all tremor subtypes (P < 0.001). Effect sizes were very large across tremor subtypes (Cohen's d > 1.00). Mean percentage improvement was comparable among resting (71.3%), postural (64.6%), and kinetic (65.1%) tremor. Similarly, the proportion of patients experiencing complete bilateral tremor resolution was consistent across tremor subtypes, 50.2% for resting, 55.8% for postural, and 51.4% for kinetic tremor.

Bilateral STN-DBS appears to improve all tremor subtypes in PD equally, including postural and kinetic tremor.