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Gait and balance in essential tremor: Variable effects of bilateral thalamic stimulation
Open accessAbstract
Essential tremor (ET) is a multi‐faceted condition best known for postural and action tremor but also may include disordered gait and postural instability. Deep brain stimulation (DBS) of the ventral intermediate nucleus (VIM) of the thalamus provides substantial tremor reduction yet some patients with bilateral VIM DBS have gait and balance impairment. This study examines gait and balance performance in 13 participants with ET who have bilateral VIM DBS compared with a matched control group. Participants with ET were tested with their stimulators off (DBS OFF) and on (DBS ON). For both standard and tandem walking, participants with ET walked significantly more slowly than controls, with significantly lower cadence, spending a lower percentage of the gait cycle in single limb support and a higher percentage in double support compared with controls. Participants with ET also had significantly lower tandem and one leg stance times, Berg balance scores, balance confidence, and required significantly greater time to perform the Timed Up‐and‐Go relative to controls. There were no significant differences in any gait or balance measures in the DBS OFF versus DBS ON conditions, but the effects of DBS on gait and balance were highly variable among individuals. Future studies are needed to determine why some individuals experience gait and balance difficulties after bilateral thalamic DBS and others do not. A better understanding of the mechanisms underlying gait and balance impairments in those with bilateral DBS is critical to reduce falls and fractures in this group. © 2008 Movement Disorder Society
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ET plus syndrome may include mild to moderate gait ataxia, cognitive impairment, personality profile changes, and mood disturbances.
“These accompanying neurological signs may include mild to moderate gait ataxia (3, 15–23), cognitive impairment (24, 25) as well as personality profile (26–28), and mood disturbances (29–31).”
From Could Wearable and Mobile Technology Improve the Management of Essential Tremor? (2018) · cites this paper as [16]
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References 18 · Cited by 76
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- Findley LJ, 1993, Indications for and clinical implications of botulinum toxin therapy, 22
Metadata
- Authors
- Earhart, G. M., Clark, B. R., Tabbal, S. D., & Perlmutter, J. S.
- Affiliations
- Washington University in St. Louis (US)
- Corresponding author
- Earhart, Gammon M.
- Venue
- Movement Disorders
- Publisher
- Wiley
- Published
- 2009-02-15
- Volume
- 24
- Issue
- 3
- Pages
- 386-391
- ISSN
- 0885-3185 (ISSN-L)
- 1531-8257
- PMC
- PMC2882155
- OpenAlex
- W1941277371
- Cited by
- 76
- References
- 18
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 4 · 2023: 1 · 2022: 4 · 2021: 4 · 2020: 5 · 2019: 10 · 2018: 5 · 2017: 4 · 2016: 6 · 2015: 3 · 2014: 3 · 2013: 5 · 2012: 3
- FWCI
- 2.54
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Movement Disorders (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Haverford College
- National Institute of Neurological Disorders and Stroke (R01NS050425, R01NS041509, R01NS058714)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (K01HD048437)
- Topics
- Health Sciences › Medicine › Clinical Neurology › Deep Brain Stimulation and Movement Disorders
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Balance, Gait, and Falls Prevention
- Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
- Keywords
- essential tremor, ventral intermediate nucleus, gait disturbance, balance disorders, postural instability, tandem walking, single limb support, Timed Up and Go test, Berg Balance Scale, balance confidence, fall risk, interindividual variability
- MeSH terms
- Adult, Aged, Postural Balance, Female, Humans, Male, Middle Aged, Severity of Illness Index, Thalamus, Treatment Outcome, Gait Disorders, Neurologic, Essential Tremor, Deep Brain Stimulation
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