Objective: To investigate the efficacy and safety of transcranial magnetic stimulation (TMS) by combined cortical and cerebellar as dual-target in the treatment of essential tremor (ET).

Background: ET, the most prevalent neurological movement disorder, presents limited therapeutic options with suboptimal efficacy. Cerebello-thalamo-cortical (CTC) dysfunction in ET implicates the cerebellum and motor cortex (M1) as neuromodulation targets. Existing single-target TMS (cerebellum/M1) shows inconsistent efficacy, we propose a novel dual-target strategy simultaneously modulating the left primary M1 and right cerebellar hemisphere.

Method: 24 patients with ET were randomly assigned to three groups: dual-target stimulation (cerebellar combined cortical stimulation), single-target stimulation (cerebellar stimulation only), or sham stimulation. Each group received 10 days of TMS. Tremor was assessed using both the TETRAS and accelerometer-based tremor analysis, at baseline (before stimulation), after the first, fifth, tenth days of treatment (D1,5,10-A), 24 h after 10 days of treatment (D10-24 h), and 1, 2, 3, and 4 weeks after stimulation (W1, 2, 3, 4). For more details on the methodology, please refer to the published protocol.

Results: Dual-target TMS is safe. In the dual-target stimulation group, no statistically significant difference was observed in the total TETRAS score at any time point when compared to D1-A. Conversely, both the single-target stimulation and sham stimulation groups demonstrated a statistically significant difference in total TETRAS scores relative to D1-A, starting from D10-A (P=0.001). This effect was maintained through W4 (P=0.002 for the single-target group and 0.018 for the sham group) （Table1）. Furthermore, within the TETRAS Performance Subscale, a statistically significant difference was noted at D10-A in the dual-target stimulation group when compared to D1-A (P=0.043). The results from the accelerometer tremor analysis are currently undergoing statistical evaluation.

Conclusion: This study establishes dual-target TMS as a clinically superior intervention for ET compared to conventional single-target approaches.

Table 1.

References: Xu J, Cao N, Qu Y, et al. Protocol for a Phase 2 randomized controlled trial: efficacy and safety of dual-target transcranial magnetic stimulation for essential tremor. Front Neurol. 2025; 15:1505154. doi:10.3389/fneur.2024.1505154

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MDS Abstracts - https://www.mdsabstracts.org/abstract/efficacy-and-safety-of-dual-target-transcranial-magnetic-stimulation-in-essential-tremor-a-phase-2-randomized-controlled-patient-assessor-blinded-trial/