Effect of stimulation frequency on tremor suppression in essential tremor

• Published in: Movement disorders Vol. 19; no. 10; pp. 1163 - 1168
• Main Authors: Ushe, Mwiza, Mink, Jonathan W., Revilla, Fredy J., Wernle, Angie, Schneider Gibson, Patricia, McGee-Minnich, Lori, Hong, Minna, Rich, Keith M., Lyons, Kelly E., Pahwa, Rajesh, Perlmutter, Joel S.
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.10.2004; Wiley
• Subjects: Adult; Aged; Biological and medical sciences; deep brain stimulation; Deep Brain Stimulation - instrumentation; Essential Tremor - therapy; Female; Humans; kinematics; Male; Medical sciences; Middle Aged; Miscellaneous; Nervous system (semeiology, syndromes); Nervous system as a whole; Neurology; Neuropharmacology; PET; Pharmacology. Drug treatments; Positron-Emission Tomography; tremor; Ventral Thalamic Nuclei - blood supply; Ventral Thalamic Nuclei - physiology; Nervous system diseases; Tremor; Neurological disorder; Motor control; Suppression; Involuntary movement
• ISSN: 0885-3185; 1531-8257
• DOI: 10.1002/mds.20231

We sought to determine the effect of deep brain stimulation (DBS) frequency on tremor suppression in essential tremor (ET) patients with deep brain stimulators implanted in the ventral intermediate nucleus (VIM) of the thalamus. A uniaxial accelerometer was used to measure tremor in the right upper extremity of subjects with a diagnosis of ET who had DBS electrodes implanted in the left VIM. The root‐mean‐square acceleration was used as the index of tremor magnitude and normalized to the OFF DBS condition. There was a highly significant inverse sigmoidal relationship between stimulation frequency and normalized tremor acceleration (X2/DoF = 0.42, r2 = 0.997). Tremor acceleration had a nearly linear response to stimulation frequencies between 45 and 100 Hz with little additional benefit above 100 Hz. These findings have two important implications. Clinically, frequency of thalamic stimulation is an important variable for optimal tremor control with maximal benefit achieved with 100 to 130 Hz in most patients. Second, thalamic DBS provides tremor benefit in a graded manner and is not an all‐or‐nothing phenomenon. © 2004 Movement Disorder Society