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Published on: December 13, 2017
Peripheral Nerve Stimulation for Essential Tremor: a Systematic Review and Meta-Analysis of Effectiveness and Safety
Mohamed El-Moslemani1, Abdallah Abbas1, Haneen Sabet2
1Faculty of Medicine, Al-Azhar University, Damietta, Egypt.
Background:
Essential tremor (ET) is the most prevalent movement disorder worldwide. There are limited current pharmacological therapies, and their side effects often preclude adequate doses. Surgical therapies, such as Deep Brain Stimulation (DBS) and Focused Ultrasound (FUS), are reserved for patients with tremor that debilitates activities of daily living (ADLs). Peripheral nerve stimulation (PNS), including transcutaneous afferent patterned stimulation (TAPS) and transcutaneous peripheral nerve stimulation (TPNS), has emerged as a promising non-invasive neuromodulatory approach for many patients with intermediate symptoms.
Methods:
A systematic review and meta-analysis following PRISMA 2020 guidelines was conducted, with searches across PubMed, Scopus, Cochrane, and Web of Science. Studies enrolling patients with ET assessing TAPS and TPNS were included. Primary outcomes were tremor severity (TETRAS performance scale, total TETRAS) and tremor amplitude. Secondary outcomes included functional disability (BF-ADL, TETRAS-mADL) and safety.
Results:
Nineteen studies (2,541 patients) were included. Sham-controlled analyses showed statistically significant improvement in TETRAS performance scale scores (MD = - 1.00; p = 0.002; I2 = 0%). BF-ADL scores improved significantly in sham-controlled analyses (MD = - 1.69; p < 0.0001) and single-arm pre-post analyses (MD = - 3.22; p < 0.0001). Tremor amplitude and total TETRAS outcomes were inconsistent, with high heterogeneity (I2 up to 94%) driven mainly by differences in assessment timing; the pooled total TETRAS estimate was not statistically significant (p = 0.16). Adverse events were mostly mild and transient; skin irritation was the most frequently reported (7.88%), and no serious adverse events were attributed to the intervention.
Conclusions:
PNS consistently improved functional outcomes with a favorable safety profile in ET patients. These findings support PNS as a viable adjunctive or on-demand non-invasive therapeutic option, particularly for medication-refractory patients or those unsuitable for surgery.
