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Current clinical application of deep-brain stimulation for essential tremor

Authors Chopra A, Klassen BT, Stead M

Received 13 February 2013

Accepted for publication 1 July 2013

Published 2 December 2013 Volume 2013:9 Pages 1859—1865

DOI https://doi.org/10.2147/NDT.S32342

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 5

Amit Chopra, Bryan T Klassen, Matt Stead

Department of Neurology, Mayo Clinic, Rochester, MN, USA

Background: Deep-brain stimulation (DBS) is an established treatment for medically refractory essential tremor (ET). This article reviews the current evidence supporting the efficacy and safety of DBS targets, including the ventral intermediate (VIM) nucleus and posterior subthalamic area (PSA) in treatment of ET.
Methods: A structured PubMed search was performed through December 2012 with keywords "deep brain stimulation (DBS)," "essential tremor (ET)," "ventral intermediate (VIM) nucleus," "posterior subthalamic area (PSA)," "safety," and "efficacy."
Results: Based on level IV evidence, both VIM and PSA DBS targets appear to be safe and efficacious in ET patients in tremor reduction and improving activities of daily living, though the literature on PSA DBS is limited in terms of bilateral stimulation and long-term follow-up. DBS-related adverse effects are typically mild and stimulation-related. Hardware-related complications after DBS may not be uncommon, and often require additional surgical procedures. Few studies assessed quality-of-life and cognition outcomes in ET patients undergoing DBS stimulation.
Conclusion: DBS appears to be a safe and effective treatment for medically refractory ET. More systematic studies comparing VIM and PSA targets are needed to ascertain the most safe and effective DBS treatment for medically refractory ET. More research is warranted to assess quality-of-life and cognition outcomes in ET patients undergoing DBS.

Keywords: deep-brain stimulation (DBS), essential tremor (ET), ventral intermediate (VIM) nucleus, posterior subthalamic area (PSA), safety, efficacy

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