Objective: Measure efficacy of dual target deep brain stimulation in pharmaco-refractory tremors.

Background: Tremor is characterised by involuntary rhythmic movement present in one or more body part¹. Essential tremor refers to a bilateral action tremor². Whereas dystonic tremor is a tremor in a region of the body affected by dystonia³. Deep brain stimulation (DBS) of ventral intermediate nucleus of the thalamus is advanced treatment for medication-refractory tremor⁴. However, decline in efficacy mean other targets are being explored⁵. This study firstly aims to measure the efficacy of dual targeting ventral intermediate nucleus (ViM) and the caudal Zona Incerta (cZI) on tremor control. A secondary aim was to evaluate which tremor type responded better to treatment.

Method: 36 patients were recruited at Walton NHS Foundation Trust, Liverpool, UK. Patients were assessed pre-operatively, 1-year, 3-years, and 5-years post-operatively with the following scales: the Fahn-Tolosa tremor rating scale The EuroQol-5D, and Hospital Anxiety and Depression Scale.

Results: ViM-cZI DBS significantly improved overall tremor score by 45.1% from baseline to 3-years post-operatively (p<0.001). It continued to show improvement in overall FTTR score by 30.7% at 5-years but this failed to meet significance. However, there was no significant improvements seen in mood or quality of life scores. ET group on average reported better clinical outcomes compared to the DT group (p>0.001).

Conclusion: Our study found that ViM-cZI DBS treatment had a favourable effect on motor symptoms sustained over the 5-years.  There was limited effect on mood and QoL, and similar trends in outcomes were seen for both tremor types.

References: 1. Bhidayasiri R. Differential diagnosis of common tremor syndromes. Vol. 81, Postgraduate Medical Journal. 2005. p. 756–62.
2. Zeuner KE, Deuschl G. An update on tremors. Curr Opin Neurol. 2012;25(4):475–82.
3. Fasano A, Bove F, Lang AE. The treatment of dystonic tremor: A systematic review. Vol. 85, Journal of Neurology, Neurosurgery and Psychiatry. BMJ Publishing Group; 2014. p. 759–69.
4. Kübler D, Kroneberg D, Al-Fatly B, Schneider GH, Ewert S, van Riesen C, et al. Determining an efficient deep brain stimulation target in essential tremor – Cohort study and review of the literature. Parkinsonism Relat Disord [Internet]. 2021 Aug 1;89:54–62. Available from: https://doi.org/10.1016/j.parkreldis.2021.06.019
5. Barbe MT, Reker P, Hamacher S, Franklin J, Kraus D, Dembek TA, et al. DBS of the PSA and the VIM in essential tremor. Neurology. 2018 Aug 7;91(6):e543–50.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/a-single-centre-retrospective-study-of-dual-target-deep-brain-stimulation-for-clinically-complex-essential-and-dystonic-tremor-a-5-year-follow-up/