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Updated: Jun 23, 2026
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MRI-guided Focused Ultrasound Thalamotomy for Patients with Medically-refractory Essential Tremor
Published on: December 13, 2017
Optimising DBS in essential tremor: clinical and neurophysiological considerations for targeting and programming
Sai A Nagaratnam1, Collin Anderson2, Victor S C Fung1
1Movement Disorders Unit, Department of Neurology, Westmead Hospital, NSW, Australia; Sydney Medical School, The University of Sydney, NSW, Australia.
Summary
Deep brain stimulation (DBS) for essential tremor (ET) can target the Vim or PSA. Targeting the posterior subthalamic area, especially the DRTT, may improve tremor control and requires a fiber-informed programming approach.
Area of Science:
- Neurosurgery
- Neurology
- Neuroscience
Background:
- Deep brain stimulation (DBS) is a key treatment for essential tremor (ET).
- Primary targets include the ventral intermediate nucleus (Vim) and posterior subthalamic area (PSA).
- These targets differ anatomically and physiologically, impacting clinical outcomes.
Purpose of the Study:
- Compare anatomical and physiological aspects of Vim versus PSA targeting in ET.
- Investigate pulse width modulation's effect on the therapeutic window.
- Emphasize fiber-informed, anatomically guided DBS programming.
Main Methods:
- Review of anatomical and physiological considerations for Vim and PSA targets.
- Analysis of pulse width modulation's impact on the therapeutic window.
- Proposal of a programming algorithm based on biophysical and anatomical data.
Main Results:
- Posterior subthalamic area (PSA) targeting, particularly the dentato-rubro-thalamic tract (DRTT), may offer superior tremor control compared to Vim.
- Longer pulse widths might better activate target neural elements in the PSA, despite some studies suggesting shorter widths widen the amplitude-defined therapeutic window.
- Variability in study design complicates direct comparisons.
Conclusions:
- A detailed understanding of target anatomy and neurophysiology is crucial for optimizing DBS programming in ET.
- Fiber-informed, anatomically guided programming can potentially improve clinical outcomes.
- An initial algorithm is proposed to guide DBS programming, moving beyond conventional monopolar review.
