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Review
. 2021 Aug 5;10(16):3468.
doi: 10.3390/jcm10163468.

Deep Brain Stimulation for Tremor: Update on Long-Term Outcomes, Target Considerations and Future Directions

Naomi I Kremer  1   2 , Rik W J Pauwels  1 , Nicolò G Pozzi  2 , Florian Lange  2 , Jonas Roothans  2 , Jens Volkmann  2 , Martin M Reich  2
Affiliations
Review

Deep Brain Stimulation for Tremor: Update on Long-Term Outcomes, Target Considerations and Future Directions

Naomi I Kremer et al. J Clin Med. .

Abstract

Deep brain stimulation (DBS) of the thalamic ventral intermediate nucleus is one of the main advanced neurosurgical treatments for drug-resistant tremor. However, not every patient may be eligible for this procedure. Nowadays, various other functional neurosurgical procedures are available. In particular cases, radiofrequency thalamotomy, focused ultrasound and radiosurgery are proven alternatives to DBS. Besides, other DBS targets, such as the posterior subthalamic area (PSA) or the dentato-rubro-thalamic tract (DRT), may be appraised as well. In this review, the clinical characteristics and pathophysiology of tremor syndromes, as well as long-term outcomes of DBS in different targets, will be summarized. The effectiveness and safety of lesioning procedures will be discussed, and an evidence-based clinical treatment approach for patients with drug-resistant tremor will be presented. Lastly, the future directions in the treatment of severe tremor syndromes will be elaborated.

Keywords: Parkinson’s disease; clinical approach; deep brain stimulation; essential tremor; future directions; outcomes; target considerations; tremor.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Deep brain stimulation targets and corresponding levels of evidence. The sphere size corresponds to the level of evidence for that specific target; higher evidence levels correspond to larger spheres. White spheres: essential tremor. Purple spheres: Parkinson’s disease. Brain nuclei: green: ventral motor part of the thalamus, sky blue: external pallidum, turquoise: internal pallidum, yellow: subthalamic nucleus, orange: substantia nigra, red: red nucleus. Grey fibers: dentato-rubro-thalamic tract.
Figure 2
Figure 2
Surgical treatment options for patients affected by drug-resistant tremor. The levels correspond to the level of evidence according to the Oxford Centre for Evidence-Based Medicine 2011. DBS: deep brain stimulation, ET: essential tremor, PD: Parkinson’s disease, Vim: ventral intermediate nucleus of the thalamus, PSA: posterior subthalamic area, DRT: dentato-rubro-thalamic tract, STN: subthalamic nucleus, GPi: internal pallidum. RF-thalamotomy: radiofrequency thalamotomy. MRgFUS: MRI-guided focused ultrasound. GK: gamma knife (radiosurgery).
See this image and copyright information in PMC

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