Cerebellar Non-Invasive Brain Stimulation for Tremor Reduction in Essential Tremor: Systematic Review and Meta-Analysis of Randomized Controlled Trials

A. Gunasekar, T. Lalotra, S. Nair, S. Khankar, N. K, R. Velusamy, A. Dey, R. Ramananthan, J. Srirangaramasamy, B. Kamaraj (Thiruvallur, India)

Meeting: 2026 International Congress

Keywords: Essential tremor(ET), Repetitive transcranial magnetic stimulation(rTMS), Transcranial magnetic stimulation(TMS)

Category: Tremor

Objective: To evaluate the safety and efficacy of cerebellar NIBS for tremor reduction in

patients with ET.

Background: Essential tremor (ET) is generally managed pharmacologically, but treatment is

often limited due to side effects or inadequate response to the therapy. Cerebellum is

primarily regarded to play central role in the pathogenesis of essential tremors. Because of its

role in tremor network, non-invasive brain stimulation (NIBS), such as repetitive transcranial

magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), which is

applied to the cerebellum is being investigated as a therapeutic alternative.

Method: We searched the databases, Pubmed, Cochrane and Scopus from inception

to February, 2026 for randomized controlled trials (RCTs) comparing active cerebellar NIBS

to sham stimulation/other therapies for ET. The primary outcome was the change in clinical

tremor severity measured by standardized scales (FTM, TCRS etc). Two independent

reviewers extracted data and assessed risk of bias using the Cochrane Risk of Bias 2 (RoB 2)

tool. The standardised mean difference was calculated using a random effects model that

included a total of 5 RCTs with 95% confidence intervals (CIs).

Results: From an initial 55 records, after screening which we included 5 RCTs involving a

total 135 patients (active NIBS: n=71; control: n=[64]). Active cerebellar NIBS resulted in a

statistically non-significant reduction in tremor severity compared to sham. While the

negative value shows certain reduction in tremors following non invasive stimulation but did

not reach statistical significance incdicated by p=0.187 and 95% confidence interval crossing

zero. The pooled effect size was -1.849. Heterogeneity was moderate where I² was calculated

to be 95.47%. There was no significant publication bias to be found after analysing with

funnel plot and egger’s weighted regression test. Reported adverse events were mild and

transient, primarily [e.g., headache, erythema], with no serious adverse events across the

trials.

Conclusion: Cerebellar NIBS is a safe and potentially effective approach for suppressing

tremor in ET. While targeting the cerebello-thalamo-cortical network shows therapeutic

promise, high variability in stimulation parameters remains a limitation. Future large-scale

RCTs are needed to standardize protocols and establish long-term clinical durability.

Forest Plot

Statistics

Funnel Plot

Asymmetry tests

PRISMA Flowchart

To cite this abstract in AMA style:

A. Gunasekar, T. Lalotra, S. Nair, S. Khankar, N. K, R. Velusamy, A. Dey, R. Ramananthan, J. Srirangaramasamy, B. Kamaraj. Cerebellar Non-Invasive Brain Stimulation for Tremor Reduction in Essential Tremor: Systematic Review and Meta-Analysis of Randomized Controlled Trials [abstract]. Mov Disord. 2026; 41 (suppl 1). https://www.mdsabstracts.org/abstract/cerebellar-non-invasive-brain-stimulation-for-tremor-reduction-in-essential-tremor-systematic-review-and-meta-analysis-of-randomized-controlled-trials/. Accessed October 1, 2026.

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