Deep brain stimulation in essential tremor: targets, technology, and a comprehensive review of clinical outcomes

Abstract

Introduction: Essential tremor (ET) is a common movement disorder with an estimated prevalence of 0.9% worldwide. Deep brain stimulation (DBS) is an established therapy for medication refractory and debilitating tremor. With the arrival of next generation technology, the implementation and delivery of DBS has been rapidly evolving. This review will highlight the current applications and constraints for DBS in ET.Areas covered: The mechanism of action, targets for neuromodulation, next generation guidance techniques, symptom-specific applications, and long-term efficacy will be reviewed.Expert opinion: The posterior subthalamic area and zona incerta are alternative targets to thalamic DBS in ET. However, they may be associated with additional stimulation-induced side effects. Novel stimulation paradigms and segmented electrodes provide innovative approaches to DBS programming and stimulation-induced side effects.

Keywords: Constant current; current steering; deep brain stimulation; essential tremor; posterior subthalamic area; segmented leads; ventralis intermedius nucleus; zona incerta.

Figure 1.. Publications of DBS for ET over time

Publication metrics obtained from PubMed utilizing the search strategy previously described.

Figure 2.. Evolution of DBS targeting in essential tremor

Row A illustrates oblique axial, coronal and sagittal views of MRI based targeting for DBS. Row B demonstrates atlas-based targeting strategies also in oblique axial, coronal and sagittal views. The white circle represents an approximation for the DBS lead tip. Row C shows 3D-reconstruction-based targeting methods centered around the thalamus.