Peripheral nerve stimulation for essential tremor: a GRADE-assessed systematic review and meta-analysis

Area of Science:

• Neurology
• Biomedical Engineering
• Clinical Research

Background:

• Essential tremor (ET) is a prevalent movement disorder with challenging management.
• Current treatments like pharmacotherapy have limited efficacy and tolerability.
• Surgical interventions are effective but invasive and costly.

Purpose of the Study:

• To systematically review and meta-analyze the efficacy and safety of peripheral nerve stimulation (PNS) for ET.
• To evaluate PNS as a non-invasive neuromodulation approach for ET management.
• To compare PNS with existing treatment options for ET.

Main Methods:

• Systematic literature search of PubMed, Scopus, Web of Science, and Cochrane CENTRAL databases.
• Meta-analysis of 12 studies (914 participants), including four RCTs, using Review Manager 5.4.1.
• Primary outcome: change in tremor intensity (TETRAS-PS); Secondary outcomes: functional disability (BF-ADL), clinical improvement (CGI-I), and safety.

Main Results:

• Active PNS significantly reduced tremor intensity (TETRAS-PS: MD=-0.92, P=0.01) and improved functional outcomes (BF-ADL: MD=-1.90, P=0.0005).
• Benefits were immediate and persisted up to three months in longitudinal studies.
• Adverse events were mild (e.g., skin irritation); no serious device-related events were reported.

Conclusions:

• PNS provides short-term tremor reduction and functional improvement in ET patients with an acceptable safety profile.
• PNS may represent a viable alternative between pharmacotherapy and invasive surgery.
• Larger, longer randomized trials with refined sham controls are necessary to confirm efficacy and optimize strategies.