Objective: To report on the results of utilization of multiple ipsilateral leads for DBS treatment of essential tremor.

Background: Thalamic VIM DBS (deep brain stimulation) is an effective therapy for patients with ET (essential tremor). However, some patients, despite seemingly appropriate lead placement, are not able to achieve adequate tremor control. The limiting factor for the amount of stimulation that can be used is often intolerable side effects of the stimulation itself. Utilization of an additional ipsilateral VO lead will allow for further field shaping to permit greater stimulation by reducing side effects, theoretically improving tremor control. We report ten patients with disabling tremor who underwent additional lead placement for improved tremor control.

Methods: Patients were referred to the Vanderbilt Movement Disorders Division, and surgical intervention was determined by a DBS Multidisciplinary Committee. Standard DBS procedure was followed. Patients were programmed and tremor rating scales were videotaped to be scored by an independent rater.

Results: Patients were assessed with standardized tremor rating scales with stimulation at each electrode individually and then across electrodes. Side effect thresholds were also determined for each electrode. Utilization of stimulation across electrodes improved tremor control in most patients by allowing for higher stimulation settings without unwanted side effects. A method for standardization of programming techniques is also described given the large combination of possible settings.

Conclusions: Addition of a second VO electrode is a viable technique to improve tremor control by allowing for further DBS field shaping which in turn permits greater stimulation or reduced side effect burden.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/unilateral-dual-lead-thalamic-deep-brain-stimulation-improves-refractory-essential-tremor/