Alternating Thalamic Deep Brain Stimulation for Essential Tremor

A Trial to Reduce Habituation

Mara Seier, Amie Peterson, Joseph Quinn, Charles Murchison, Matthew Brodsky, Shannon Anderson

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: DBS in the ventral intermediate nucleus (VIM) of the thalamus has been a revolutionary treatment for patients with essential tremor (ET) by reducing tremor. Unfortunately, some patients develop habituation to DBS and thus experience reduced efficacy and loss of tremor control. There are no standardized methods of addressing habituation to DBS. We propose alternating stimulation patterns as a way to reduce habituation. Methods: This was a randomized, placebo-controlled trial for patients with VIM DBS for ET. Patients were randomized to either experimental treatment arm of alternating stimulation patterns on a weekly basis or standard care arm of continuous stimulation settings for 12 weeks. Primary outcome was change in the performance subscale of The Essential Tremor Rating Assessment Scale (TETRAS), which was performed at initial visit and 12-week follow-up. Secondary outcome included change in the activities of daily living subscale of TETRAS. Results: Twenty-two patients were enrolled in the trial, and 16 were analyzed at follow-up. Experimental treatment subjects displayed sustained tremor control compared to standard care, as measured by the change in TETRAS performance subscale (–0.6 vs. 6.7 point change, respectively) with a 7.3 difference between the arms (P = 0.006). Conclusion: Alternating stimulation patterns on a weekly basis for ET patients with VIM DBS reduced habituation in this pilot study. This study suggests that exposure to different stimulation groups may maintain better tremor control compared to constant stimulation parameters.

Original languageEnglish (US)
JournalMovement Disorders Clinical Practice
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Essential Tremor
Deep Brain Stimulation
Tremor
Ventral Thalamic Nuclei
Standard of Care
Activities of Daily Living
Therapeutics
Randomized Controlled Trials
Placebos

Keywords

  • deep brain stimulation
  • essential tremor
  • habituation
  • VIM

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

Cite this

Alternating Thalamic Deep Brain Stimulation for Essential Tremor : A Trial to Reduce Habituation. / Seier, Mara; Peterson, Amie; Quinn, Joseph; Murchison, Charles; Brodsky, Matthew; Anderson, Shannon.

In: Movement Disorders Clinical Practice, 01.01.2018.

Research output: Contribution to journalArticle

@article{65e1230b4096466898115a0a9da642d3,
title = "Alternating Thalamic Deep Brain Stimulation for Essential Tremor: A Trial to Reduce Habituation",
abstract = "Background: DBS in the ventral intermediate nucleus (VIM) of the thalamus has been a revolutionary treatment for patients with essential tremor (ET) by reducing tremor. Unfortunately, some patients develop habituation to DBS and thus experience reduced efficacy and loss of tremor control. There are no standardized methods of addressing habituation to DBS. We propose alternating stimulation patterns as a way to reduce habituation. Methods: This was a randomized, placebo-controlled trial for patients with VIM DBS for ET. Patients were randomized to either experimental treatment arm of alternating stimulation patterns on a weekly basis or standard care arm of continuous stimulation settings for 12 weeks. Primary outcome was change in the performance subscale of The Essential Tremor Rating Assessment Scale (TETRAS), which was performed at initial visit and 12-week follow-up. Secondary outcome included change in the activities of daily living subscale of TETRAS. Results: Twenty-two patients were enrolled in the trial, and 16 were analyzed at follow-up. Experimental treatment subjects displayed sustained tremor control compared to standard care, as measured by the change in TETRAS performance subscale (–0.6 vs. 6.7 point change, respectively) with a 7.3 difference between the arms (P = 0.006). Conclusion: Alternating stimulation patterns on a weekly basis for ET patients with VIM DBS reduced habituation in this pilot study. This study suggests that exposure to different stimulation groups may maintain better tremor control compared to constant stimulation parameters.",
keywords = "deep brain stimulation, essential tremor, habituation, VIM",
author = "Mara Seier and Amie Peterson and Joseph Quinn and Charles Murchison and Matthew Brodsky and Shannon Anderson",
year = "2018",
month = "1",
day = "1",
doi = "10.1002/mdc3.12685",
language = "English (US)",
journal = "Movement Disorders Clinical Practice",
issn = "2330-1619",
publisher = "John Wiley and Sons Ltd",

}

TY - JOUR

T1 - Alternating Thalamic Deep Brain Stimulation for Essential Tremor

T2 - A Trial to Reduce Habituation

AU - Seier, Mara

AU - Peterson, Amie

AU - Quinn, Joseph

AU - Murchison, Charles

AU - Brodsky, Matthew

AU - Anderson, Shannon

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: DBS in the ventral intermediate nucleus (VIM) of the thalamus has been a revolutionary treatment for patients with essential tremor (ET) by reducing tremor. Unfortunately, some patients develop habituation to DBS and thus experience reduced efficacy and loss of tremor control. There are no standardized methods of addressing habituation to DBS. We propose alternating stimulation patterns as a way to reduce habituation. Methods: This was a randomized, placebo-controlled trial for patients with VIM DBS for ET. Patients were randomized to either experimental treatment arm of alternating stimulation patterns on a weekly basis or standard care arm of continuous stimulation settings for 12 weeks. Primary outcome was change in the performance subscale of The Essential Tremor Rating Assessment Scale (TETRAS), which was performed at initial visit and 12-week follow-up. Secondary outcome included change in the activities of daily living subscale of TETRAS. Results: Twenty-two patients were enrolled in the trial, and 16 were analyzed at follow-up. Experimental treatment subjects displayed sustained tremor control compared to standard care, as measured by the change in TETRAS performance subscale (–0.6 vs. 6.7 point change, respectively) with a 7.3 difference between the arms (P = 0.006). Conclusion: Alternating stimulation patterns on a weekly basis for ET patients with VIM DBS reduced habituation in this pilot study. This study suggests that exposure to different stimulation groups may maintain better tremor control compared to constant stimulation parameters.

AB - Background: DBS in the ventral intermediate nucleus (VIM) of the thalamus has been a revolutionary treatment for patients with essential tremor (ET) by reducing tremor. Unfortunately, some patients develop habituation to DBS and thus experience reduced efficacy and loss of tremor control. There are no standardized methods of addressing habituation to DBS. We propose alternating stimulation patterns as a way to reduce habituation. Methods: This was a randomized, placebo-controlled trial for patients with VIM DBS for ET. Patients were randomized to either experimental treatment arm of alternating stimulation patterns on a weekly basis or standard care arm of continuous stimulation settings for 12 weeks. Primary outcome was change in the performance subscale of The Essential Tremor Rating Assessment Scale (TETRAS), which was performed at initial visit and 12-week follow-up. Secondary outcome included change in the activities of daily living subscale of TETRAS. Results: Twenty-two patients were enrolled in the trial, and 16 were analyzed at follow-up. Experimental treatment subjects displayed sustained tremor control compared to standard care, as measured by the change in TETRAS performance subscale (–0.6 vs. 6.7 point change, respectively) with a 7.3 difference between the arms (P = 0.006). Conclusion: Alternating stimulation patterns on a weekly basis for ET patients with VIM DBS reduced habituation in this pilot study. This study suggests that exposure to different stimulation groups may maintain better tremor control compared to constant stimulation parameters.

KW - deep brain stimulation

KW - essential tremor

KW - habituation

KW - VIM

UR - http://www.scopus.com/inward/record.url?scp=85056350421&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85056350421&partnerID=8YFLogxK

U2 - 10.1002/mdc3.12685

DO - 10.1002/mdc3.12685

M3 - Article

JO - Movement Disorders Clinical Practice

JF - Movement Disorders Clinical Practice

SN - 2330-1619

ER -