Objective: Characterize patients with essential tremor (ET) referred to a tertiary center for deep brain stimulation (DBS), including reasons for not proceeding with surgery.

Background: ET is the most common tremor disorder. For medically-refractory tremor, DBS to the ventral intermediate nucleus of the thalamus (VIM) is effective, and has become increasingly utilized. The evaluation process is time- and resource-consuming; therefore, it is crucial to refer appropriate patients. There are few reports describing the characteristics of patients referred for DBS, as well as reasons that some do not proceed with surgical intervention.

Method: We conducted a retrospective chart review of patients with ET referred for DBS evaluation at our institution between January 2011 and February 2019. Patients were excluded if they did not complete the entire evaluation process.

Results: Sixty-seven patients were included in this analysis. The average age was 66 years at the time of referral (range 22-87). A minority of patients (30%) were woman; all were Caucasian. Forty-nine patients (73%) reported a family history of tremor. Nearly all (94%) had tried at least two medications, the most common being propranolol (87%), primidone (84%), topiramate (60%), and gabapentin (49%). Thirty-six patients (55%) underwent surgery; of those, 25 (39%) were bilateral and 11 (16%) were unilateral procedures. All electrodes were implanted into VIM. Twelve patients (18%) were approved for surgery but did not proceed. The most common reasons included perceived risk (n=4) and decision to pursue surgery elsewhere (n=3). Five patients were lost to follow-up after the evaluation. Nineteen patients were not approved for surgery for the following reasons: increased risk relative to benefit (n=6), unclear diagnosis (n=5), insufficient medication trials (n = 4), cognitive impairment (n=2), and poor social support (n=2).

Conclusion: In a cohort of patients with medically-refractory ET referred for DBS, baseline demographics show a predominantly white male population with a strong family history of tremor and multiple medication trials. Only half of the patients who were evaluated ultimately underwent surgery. Our data suggest that efforts should be made to educate patients about the details of DBS surgery, ensure an exact diagnosis, and perform an adequate medication trial prior to starting the evaluation process.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/characteristics-of-patients-with-essential-tremor-evaluated-for-deep-brain-stimulation-surgery-at-a-tertiary-center/