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

Authors: Kremer NI, Pauwels RWJ, Pozzi NG, Lange F, Roothans J, Volkmann J, Reich MM

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.

Introduction

Purpose Thermal ablation

Study Objective To review evidence on DBS targets and lesioning procedures and present an evidence-based clinical treatment approach for patients with drug-resistant tremor.

Disease model drug-resistant tremor (tremor syndromes)

Targeted brain region(s) Thalamic Ventral Intermediate Nucleus

Outcomes and Safety

Summary of Outcomes Thalamic VIM deep brain stimulation and alternative lesioning procedures (radiofrequency thalamotomy, focused ultrasound, radiosurgery) effectively reduce drug‑resistant tremor, and targeting the posterior subthalamic area (PSA) or dentato‑rubro‑thalamic tract (DRT) also shows clinical benefit. The review did not report or compare specific focused ultrasound parameter settings.

Safety-related matter The paper notes that "the effectiveness and safety of lesioning procedures will be discussed," but the provided excerpt does not report any specific adverse effects or safety findings.

Brain Region

Ultrasound Parameters

Focal Characteristics Focal depth: None; Focal length: None; Aperture size: None

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