The safety and efficacy of thalamic deep brain stimulation in essential tremor: 10 years and beyond
Open accessAbstract
BACKGROUND: Deep brain stimulation (DBS) has proven to be a safe and effective therapy for refractory essential tremor, but information regarding long-term outcomes is lacking. OBJECTIVES: We aimed to assess the long-term safety and efficacy of DBS in patients with essential tremor. METHODS: Patients treated with DBS for essential tremor for at least 8 years were evaluated in the 'on' and 'off' state using the Fahn-Tolosa-Marin tremor rating scale, and their medical records were reviewed to assess complications related to this therapy. RESULTS: We studied 13 patients (7 men): median age at evaluation 79 years (range 47-88), median age at electrode implantation 68 years (range 37-78) and mean time since electrode implantation 132.54±15.3 months (range 114-164). The difference between the 'off' and 'on' state on the motor items of the tremor rating scale was 41.9% (58.62 vs. 34.08, p<0.001) in the non-blinded and 37.2% (56.07 vs. 35.23, p<0.001) in the blinded rating. DBS provided a functional improvement of 31.7% in the 'on' state (15.07 vs. 22.07, p<0.001). A total non-blinded improvement in the tremor rating scale of 39% was observed in the 'on' state (49.15 vs. 80.69, p<0.001). Dysarthria and disequilibrium were common in patients with bilateral stimulation. A DBS-related surgery (electrode revision or internal pulse generator exchange) was necessary on average every 47.9 months to continue with the DBS therapy. CONCLUSIONS: Thalamic DBS is a safe and effective therapy in patients with essential tremor followed for up to 13 years.
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Essential tremor is usually intermittent and occurs mainly during voluntary movement or while holding a posture.
“Tremor in ET is typically intermittent, predominantly occurring during voluntary movement and/or while maintaining a certain posture[2].”
From Closed-loop DBS triggered by real-time movement and tremor decoding based on thalamic LFPs for essential tremor (2020) · cites this paper as [2]
The Results and Table 2 report postural and action tremor in patients with essential tremor, consistent with tremor occurring while holding a posture or moving. The paper does not describe tremor as typically intermittent, and its measurements in a small DBS-treated group do not establish that these are the predominant circumstances for essential tremor generally. (LLM, conf=0.83)
Experimental — accuracy not yet measuredPrior closed-loop deep brain stimulation studies have used wearable inertial sensors, surface electromyography, or electrocorticography from a cortical strip to provide feedback for stimulator control.
“Some existing studies have used wearable inertial sensors [7], surface electromyography (EMG) [8], or electrocorticography (ECoG) recorded from a Neurosciences strip of intracranial electrodes implanted over the surface of the motor cortex [9] to provide feedback for the control of the stimulator in closed-loop DBS systems.”
From Closed-loop DBS triggered by real-time movement and tremor decoding based on thalamic LFPs for essential tremor (2020) · cites this paper as [9]
The citation [9] is attached to the ECoG example. The Patients and Methods section describes thalamic DBS with constant-voltage stimulation and clinician-adjusted settings, but our copy does not describe cortical-strip ECoG recordings used as feedback for closed-loop control. Searches for ECoG, cortical recording, feedback, and adaptive stimulation found no supporting passage. (LLM, conf=0.75)
Experimental — accuracy not yet measuredAll these existing closed-loop deep brain stimulation solutions require external sensors or additional invasive recording, which limits their clinical use in essential tremor.
“However, all these solutions require external sensors and/or additional invasive recording, which constrains their clinical application in the treatment of ET.”
From Closed-loop DBS triggered by real-time movement and tremor decoding based on thalamic LFPs for essential tremor (2020) · cites this paper as [9]
The Patients and Methods section describes constant-voltage DBS with parameters adjusted after implantation, while the Results and Discussion address long-term outcomes and complications. Searches for closed-loop stimulation, external sensors, and additional invasive recording found no passage addressing whether such requirements constrain clinical use in essential tremor. (LLM, conf=0.76)
Experimental — accuracy not yet measured
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- [23]23. Baizabal-Carvallo JF, et al. J Neurol Neurosurg Psychiatry 2014;85:567-572. doi:10.1136/jnnp-2013-304943 Movement disorders copyright. on February 19, 2024 by guest. Protected by http://jnnp.bmj.com/ J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp-2013-304943 on 4 October 2013. Downloaded from
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- Authors
- Baizabal-Carvallo, J. F., Kagnoff, M. N., Jimenez-Shahed, J., Fekete, R., & Jankovic, J.
- Affiliations
- Baylor College of Medicine (US)
- Corresponding author
- Jankovic, J.
- Venue
- Journal of Neurology, Neurosurgery & Psychiatry
- Publisher
- BMJ
- Published
- 2013-10-04
- Volume
- 85
- Issue
- 5
- Pages
- 567-572
- ISSN
- 0022-3050 (ISSN-L)
- OpenAlex
- W2100314836
- Semantic Scholar
- b829c8274cc11c61a573c9b5d8a68b0518399ffc
- Cited by
- 181
- References
- 24
- Citations by year
- 2026: 2 · 2025: 9 · 2024: 16 · 2023: 11 · 2022: 7 · 2021: 12 · 2020: 23 · 2019: 19 · 2018: 20 · 2017: 24 · 2016: 20 · 2015: 12 · 2014: 5 · 2013: 1
- FWCI
- 8.04
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Neurology Neurosurgery & Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Touro Scholar (Touro College) (submittedVersion)
- HighWire Press Open Archive (submittedVersion)
- Topics
- Health Sciences › Medicine › Neurology › Neurological disorders and treatments
- Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
- Health Sciences › Medicine › Neurology › Botulinum Toxin and Related Neurological Disorders
- Keywords
- thalamic stimulation, essential tremor, long-term outcomes, safety, efficacy, Fahn-Tolosa-Marin Tremor Rating Scale, dysarthria, disequilibrium, bilateral stimulation
- MeSH terms
- Aged, Aged, 80 and over, Dysarthria, Female, Follow-Up Studies, Humans, Male, Middle Aged, Thalamus, Time Factors, Treatment Outcome, Gait Disorders, Neurologic, Essential Tremor, Deep Brain Stimulation
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