Objective: In this work, we aimed to suppress wrist tremors in individuals affected by Parkinson’s disease (PD) and essential tremor (ET) using targeted, high frequency peripheral nerve stimulation.

Background: Upper-limb tremors resulting from PD or ET affect about 6% of the global population. These tremors often make activities of daily living difficult to complete, leading to depressed quality of life. Existing treatments such as pharmacotherapy and intracranial procedures are limited in widespread applicability, leaving many patients untreated. Peripheral nerve stimulation (PNS) is a non-invasive alternative which can be tailored to the user. The most effective application of PNS is the fatigue-inducing functional electrical stimulation (FES), with tremor suppression ratios in the 50th percentile. Here, we aim to suppress tremors using non-fatiguing, sensory electrical stimulation (SES), which avoids disruption of the user’s motion and active limb stiffening. We expanded the number of stimulation-sites compared to previous studies while introducing the use of high frequency deep interferential current (DIC) stimulation as a specialized application of SES for postural wrist tremor suppression.

Method: 1 PD (S1) and 1 ET (S2) subject completed a minute-long cup-lift-and-hold task as we collected baseline (15 seconds) and with-stimulation (45 seconds, either a DIC or SES protocol applied to each subject’s flexor carpi radialis, extensor carpi radialis, pronator, and supinator) inertial measurement unit (IMU) data. We used the same amplitude of 4 mA and outer pulse frequency of 10 Hz for both stim type with a 2 kHz carrier frequency for DIC. Each subject underwent 5 DIC trials and 3 SES trials. IMU-given angular velocity data was used to calculate tremor suppression ratios from the with-stimulation portion of each trial compared to baseline.

Results: The average tremor suppression ratio for each of 3 degrees of freedom (Fig. 1) is given for each subject in Fig. 2. Our PD and ET subjects experienced different scales of tremor suppression for both stimulation types, with the highest suppression (~60%) observed for the PD subject during SES.

Conclusion: Wrist tremor suppression occurred during SES and DIC for both subjects, demonstrating the viability of our 4 stimulation-site approach and the potential for significant protocol optimization for DIC stimulation.

Figure 1

Figure 2

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MDS Abstracts - https://www.mdsabstracts.org/abstract/upper-limb-tremor-suppression-using-targeted-high-frequency-peripheral-nerve-stimulation/