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. 2008 Apr;5(2):331–338. doi: 10.1016/j.nurt.2008.01.004

Deep brain stimulation and tremor

Kelly E Lyons 1,✉, Rajesh Pahwa 1
PMCID: PMC5084174  PMID: 18394574

Summary

Deep brain stimulation (DBS) has been used to treat various tremor disorders for several decades. Medication-resistant, disabling essential tremor (ET) is the most common tremor disorder treated with DBS. The treatment has been consistently reported to result in significant benefit in upper extremity, as well as head and voice tremor, all of which were improved more dramatically with bilateral procedures. These benefits have been demonstrated to be sustained for up to 7 years. DBS has also been shown to be beneficial for the tremor associated with multiple sclerosis and post-traumatic tremor; however, fewer cases have been reported and the benefit is less consistent, less dramatic, and more transient than that seen with ET. The ventral intermediate nucleus of the thalamus is the most common DBS target for tremor disorders, but more recent studies have demonstrated benefits in tremor from DBS of the subthalamic area, primarily the zona incerta. Surgical complications are relatively uncommon and are generally less frequent than those seen with thalamotomy. Stimulation-related effects are usually mild and resolve with adjustment of stimulation parameters. DBS is thus a relatively safe and effective treatment for tremor disorders, particularly for medication-resistant, disabling ET, but may also have some role in medication-resistant, disabling tremor associated with multiple sclerosis and traumatic head injury.

Key Words: Deep brain stimulation, tremor, essential tremor, primary writing tremor, multiple sclerosis tremor, post-traumatic tremor

References

  • 1.Deuschl G, Bain P, Brin M, Ad Hoc Scientific Committee Consensus statement of the Movement Disorder Society on Tremor. Mov Disord. 1998;13(Suppl 3):2–23. doi: 10.1002/mds.870131303. [DOI] [PubMed] [Google Scholar]
  • 2.Lyons KE, Pahwa R, Comella CL, et al. Benefits and risks of pharmacological treatments for essential tremor. Drug Saf. 2003;26:461–481. doi: 10.2165/00002018-200326070-00003. [DOI] [PubMed] [Google Scholar]
  • 3.Olanow CW, Watts RL, Koller WC. An algorithm (decision tree) for the management of Parkinson’s disease (2001): treatment guidelines. Neurology. 2001;56(11):S1–S88. doi: 10.1212/wnl.56.suppl_5.s1. [DOI] [PubMed] [Google Scholar]
  • 4.Pahwa R, Lyons KE. Essential tremor: differential diagnosis and current therapy. Am J Med. 2003;115:134–142. doi: 10.1016/S0002-9343(03)00259-6. [DOI] [PubMed] [Google Scholar]
  • 5.Deuschl G, Bain P. Deep brain stimulation for trauma [collection of trauma]: patient selection and evaluation. Mov Disord. 2002;17(Supp13):S102–S111. doi: 10.1002/mds.10150. [DOI] [PubMed] [Google Scholar]
  • 6.Hassler R, Riechert T, Mundinger F, Umbach W, Ganglberger JA. Physiological observations in stereotaxic operations in extrapyramidal motor disturbances. Brain. 1960;83:337–350. doi: 10.1093/brain/83.2.337. [DOI] [PubMed] [Google Scholar]
  • 7.Benabid AL, Pollak P, Gao D, et al. Chronic electrical stimulation of the ventralis intermedius nucleus of the thalamus as a treatment of movement disorders. J Neurosurg. 1996;84:203–214. doi: 10.3171/jns.1996.84.2.0203. [DOI] [PubMed] [Google Scholar]
  • 8.Tasker RR. Deep brain stimulation is preferable to thalamotomy for tremor suppression. Surg Neurol. 1998;49:145–153. doi: 10.1016/S0090-3019(97)00459-X. [DOI] [PubMed] [Google Scholar]
  • 9.Schuurman PR, Bosch DA, Bossuyt PM, et al. A comparison of continuous thalamic stimulation and thalamotomy for suppression of severe tremor. N Engl J Med. 2000;342:461–468. doi: 10.1056/NEJM200002173420703. [DOI] [PubMed] [Google Scholar]
  • 10.Pahwa R, Lyons KE, Wilkinson SB, et al. Comparison of thalamotomy to deep brain stimulation of the thalamus in essential tremor. Mov Disord. 2001;16:140–143. doi: 10.1002/1531-8257(200101)16:1<140::AID-MDS1025>3.0.CO;2-T. [DOI] [PubMed] [Google Scholar]
  • 11.Koller W, Pahwa R, Busenbark K, et al. High-frequency unilateral thalamic stimulation in the treatment of essential and parkinsonian tremor. Ann Neurol. 1997;42:292–299. doi: 10.1002/ana.410420304. [DOI] [PubMed] [Google Scholar]
  • 12.Pahwa R, Lyons KE, Wilkinson SB, et al. Long-term evaluation of deep brain stimulation of the thalamus. J Neurosurg. 2006;104:506–512. doi: 10.3171/jns.2006.104.4.506. [DOI] [PubMed] [Google Scholar]
  • 13.Limousin P, Speelman JD, Gielen F, Janssens M. Multicentre European study of thalamic stimulation in parkinsonian and essential tremor. J Neurol Neurosurg Psychiatry. 1999;66:289–296. doi: 10.1136/jnnp.66.3.289. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 14.Sydow O, Thobois S, Alesch F, Speelman JD. Multicentre European study of thalamic stimulation in essential tremor: a six year follow up. J Neurol Neurosurg Psychiatry. 2003;74:1387–1391. doi: 10.1136/jnnp.74.10.1387. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 15.Koller WC, Lyons KE, Wilkinson SB, Troster AI, Pahwa R. Long-term safety and efficacy of unilateral deep brain stimulation of the thalamus in essential tremor. Mov Disord. 2001;16:464–468. doi: 10.1002/mds.1089. [DOI] [PubMed] [Google Scholar]
  • 16.Putzke JD, Wharen RE, Obwegeser AA, et al. Thalamic deep brain stimulation for essential tremor: recommendations for long-term outcome analysis. Can J Neurol Sci. 2004;31:333–342. doi: 10.1017/s0317167100003413. [DOI] [PubMed] [Google Scholar]
  • 17.Ondo W, Jankovic J, Schwartz K, Almaguer M, Simpson RK. Unilateral thalamic deep brain stimulation for refractory essential tremor and Parkinson’s disease tremor. Neurology. 1998;51:1063–1069. doi: 10.1212/wnl.51.4.1063. [DOI] [PubMed] [Google Scholar]
  • 18.Blond S, Siegfried J. Thalamic stimulation for the treatment of tremor and other movement disorders. Acta Neurochir Suppl. 1991;52:109–111. doi: 10.1007/978-3-7091-9160-6_30. [DOI] [PubMed] [Google Scholar]
  • 19.Alesch F, Pinter MM, Helscher RJ, Fertl L, Benabid AL, Koos WT. Stimulation of the ventral intermediate thalamic nucleus in tremor dominated Parkinson’s disease and essential tremor. Acta Neurochir. 1995;136:75–81. doi: 10.1007/BF01411439. [DOI] [PubMed] [Google Scholar]
  • 20.Hariz GM, Bergenheim AT, Hariz MI, Lindberg M. Assessment of ability/disability in patients treated with chronic thalamic stimulation for tremor. Mov Disord. 1998;13:78–83. doi: 10.1002/mds.870130117. [DOI] [PubMed] [Google Scholar]
  • 21.Kumar K, Kelly M, Toth C. Deep brain stimulation of the ventral intermediate nucleus of the thalamus for control of tremors in Parkinson’s disease and essential tremor. Stereotact Funct Neurosurg. 1999;72:47–61. doi: 10.1159/000029671. [DOI] [PubMed] [Google Scholar]
  • 22.Krauss JK, Simpson RK, Ondo WG, Pohle T, Burgunder JM, Jankovic J. Concepts and methods in chronic thalamic stimulation for treatment of tremor: technique and application. Neurosurgery. 2001;48:535–541. doi: 10.1097/00006123-200103000-00015. [DOI] [PubMed] [Google Scholar]
  • 23.Rehncrona S, Johnels B, Widner H, Tornqvist AL, Hariz M, Sydow O. Long-term efficacy of thalamic deep brain stimulation for tremor: double-blind assessments. Mov Disord. 2003;18:163–170. doi: 10.1002/mds.10309. [DOI] [PubMed] [Google Scholar]
  • 24.Putzke JD, Wharen RE, Wszolek ZK, Turk MF, Strongosky AJ, Uitti RJ. Thalamic deep brain stimulation for tremor-predominant Parkinson’s disease. Parkinsonism Relat Disord. 2003;10:81–88. doi: 10.1016/j.parkreldis.2003.09.002. [DOI] [PubMed] [Google Scholar]
  • 25.Putzke JD, Uitti RJ, Obwegeser AA, Wszolek ZK, Wharen RE. Bilateral thalamic deep brain stimulation: midline tremor control. J Neurol Neurosurg Psychiatry. 2005;76:684–690. doi: 10.1136/jnnp.2004.041434. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 26.Koller WC, Lyons KE, Wilkinson SB, Pahwa R. Efficacy of unilateral deep brain stimulation of the VIM nucleus of the thalamus for essential head tremor. Mov Disord. 1999;14:847–850. doi: 10.1002/1531-8257(199909)14:5<847::AID-MDS1021>3.0.CO;2-G. [DOI] [PubMed] [Google Scholar]
  • 27.Berk C, Honey CR. Bilateral thalamic deep brain stimulation for the treatment of head tremor: report of two cases. J Neurosurg. 2002;96:615–618. doi: 10.3171/jns.2002.96.3.0615. [DOI] [PubMed] [Google Scholar]
  • 28.Kitagawa M, Murata J, Kikuchi S, et al. Deep brain stimulation of subthalamic area for severe proximal tremor. Neurology. 2000;55:114–116. doi: 10.1212/wnl.55.1.114. [DOI] [PubMed] [Google Scholar]
  • 29.Murata J, Kitagawa M, Uesugi H, et al. Electrical stimulation of the posterior subthalamic area for the treatment of intractable proximal tremor. J Neurosurg. 2003;99:708–715. doi: 10.3171/jns.2003.99.4.0708. [DOI] [PubMed] [Google Scholar]
  • 30.Plaha P, Patel NK, Gill SS. Stimulation of the subthalamic region for essential tremor. J Neurosurg. 2004;101:48–54. doi: 10.3171/jns.2004.101.1.0048. [DOI] [PubMed] [Google Scholar]
  • 31.Minguez-Castellanos A, Carnero-Pardo C, Gómez-Camello A, et al. Primary writing tremor treated by chronic thalamic stimulation. Mov Disord. 1999;14:1030–1033. doi: 10.1002/1531-8257(199911)14:6<1030::AID-MDS1021>3.0.CO;2-O. [DOI] [PubMed] [Google Scholar]
  • 32.Racette BA, Dowling J, Randle J, Mink JW. Thalamic stimulation for primary writing tremor. J Neurol. 2001;248:380–382. doi: 10.1007/s004150170177. [DOI] [PubMed] [Google Scholar]
  • 33.Geny C, Nguyen JP, Pollin B, et al. Improvement of severe postural cerebellar tremor in multiple sclerosis by chronic thalamic stimulation. Mov Disord. 1996;11:489–494. doi: 10.1002/mds.870110503. [DOI] [PubMed] [Google Scholar]
  • 34.Montgomery EB, Baker KB, Kinkel RP, Barnett G. Chronic thalamic stimulation for the tremor of multiple sclerosis. Neurology. 1999;53:625–628. doi: 10.1212/wnl.53.3.625. [DOI] [PubMed] [Google Scholar]
  • 35.Schulder M, Sernas T, Mahalick D, Adler R, Cook S. Thalamic stimulation in patients with multiple sclerosis. Stereotact Funct Neurosurg. 1999;72:196–201. doi: 10.1159/000029726. [DOI] [PubMed] [Google Scholar]
  • 36.Schulder M, Sernas TJ, Karimi R. Thalamic stimulation in patients with multiple sclerosis: long-term follow-up. Stereotact Funct Neurosurg. 2003;80:48–55. doi: 10.1159/000075160. [DOI] [PubMed] [Google Scholar]
  • 37.Berk C, Carr J, Sinden M, Martzke J, Honey CR. Thalamic deep brain stimulation for the treatment of tremor due to multiple sclerosis: a prospective study of tremor and quality of life. J Neurosurg. 2002;97:815–820. doi: 10.3171/jns.2002.97.4.0815. [DOI] [PubMed] [Google Scholar]
  • 38.Wishart HA, Roberts DW, Roth RM, et al. Chronic deep brain stimulation for the treatment of tremor in multiple sclerosis: review and case reports. J Neurol Neurosurg Psychiatry. 2003;74:1392–1397. doi: 10.1136/jnnp.74.10.1392. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 39.Yap L, Kouyialis A, Varma TR. Stereotactic neurosurgery for disabling tremor in multiple sclerosis: thalamotomy or deep brain stimulation? Br J Neurosurg. 2007;21:349–354. doi: 10.1080/02688690701544002. [DOI] [PubMed] [Google Scholar]
  • 40.Nandi D, Aziz TZ. Deep brain stimulation in the management of neuropathic pain and multiple sclerosis tremor. J Clin Neurophysiol. 2004;21:31–39. doi: 10.1097/00004691-200401000-00005. [DOI] [PubMed] [Google Scholar]
  • 41.Krauss JK, Jankovic J. Head injury and posttraumatic movement disorders. Neurosurgery. 2002;50:927–939. doi: 10.1097/00006123-200205000-00003. [DOI] [PubMed] [Google Scholar]
  • 42.Broggi G, Brock S, Franzini A, Geminiani G. A case of posttraumatic tremor treated by chronic stimulation of the thalamus. Mov Disord. 1993;8:206–208. doi: 10.1002/mds.870080217. [DOI] [PubMed] [Google Scholar]
  • 43.Umemura A, Samadani U, Jaggi JL, Hurtig HI, Baituch GH. Thalamic deep brain stimulation for posttraumatic action tremor. Clin Neurol Neurosurg. 2004;106:280–283. doi: 10.1016/j.clineuro.2003.12.004. [DOI] [PubMed] [Google Scholar]
  • 44.Foote KD, Okun MS. Ventralis intermedius plus ventralis oralis anterior and posterior deep brain stimulation for posttraumatic Holmes tremor: two leads may be better than one: technical note. Neurosurgery. 2005;56:E445–E445. doi: 10.1227/01.NEU.0000157104.87448.78. [DOI] [PubMed] [Google Scholar]

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