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Published on: December 13, 2017
The effect of thalamic deep brain stimulation on obstacle clearance in essential tremor
Yoon Jin Choi1, Basma Yacoubi1, Stefan Delmas1
1Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL 32601, USA.
Objective:
Individuals with essential tremor (ET) face a higher risk of falls, but their obstacle navigation and the effects of thalamic deep brain stimulation (DBS) remain poorly understood.
Methods:
Fourteen ET with DBS and 10 healthy older adults (OA) completed an overground walk with obstacle clearance. We measured (1) foot clearance, (2) tremor, (3) EMG-EMG synchrony, (4) total time duration, (5) dysmetria, (6) MoCA, and (7) BDI.
Results:
ET exhibited lower leading and trailing foot clearance than OA. With DBS ON, both the leading and trailing foot clearance significantly increased relative to DBS OFF. The DBS-induced increase in leading foot clearance was significantly associated with the reduction in axial tremor (R2 = 0.54) and with the increase in EMG-EMG synchrony in the axial muscles (R2 = 0.42). The DBS-induced reduction in total time duration was significantly associated with the increase in leading foot clearance (R2 = 0.37), and with the reduction in axial tremor (R2 = 0.44). Dysmetria, MoCA, and BDI scores were not associated with foot clearance.
Conclusions:
Thalamic neurostimulation increases obstacle clearance in individuals with ET, likely by mitigating axial tremor.
Significance:
These findings highlight the importance of targeting axial tremor when optimizing DBS settings, as this could improve its therapeutic efficacy in mitigating fall risk.
