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In this randomized, sham-controlled trial, MRI-guided focused ultrasound thalamotomy reduced hand tremor in patients with essential tremor who had not had a response to medication. Adverse effects of the procedure included sensory deficits and gait disturbances. Essential tremor, the most common movement disorder, 1 is characterized by a distinctive postural and intention tremor typically affecting the hands more than the legs, trunk, head, or voice. 2 , 3 Essential tremor does not shorten life expectancy, but it can affect quality of life, functional activities, mood, and socialization. 4 – 6 Class I evidence exists for propranolol and primidone as first-line medications that reduce tremor by approximately 60% in 50% of patients. 7 – 11 If resistance to medications develops or side effects are unacceptable, neurosurgical intervention is considered, primarily targeting the nucleus ventralis intermedius of the thalamus, a component of tremor circuitry that . . .

Injection of botulinum toxin into each splenius capitis muscle at baseline and week 12 was more effective than placebo in reducing the severity of essential head tremor over 18 weeks. Effects waned at 24 weeks.

In an uncontrolled, open-label pilot study, essential tremor improved in 15 patients treated with MRI-guided focused ultrasound thalamotomy. Adverse effects included persistent paresthesias in four patients. The study was too small to assess the safety of this procedure. Essential tremor, the most common movement disorder, with a prevalence as high as 4%, is characterized by a rhythmic oscillation of agonist and antagonist muscle groups, typically between 8 and 12 Hz. 1 The cause of this disorder remains unknown, although there is often a familial component with a link to a particular polymorphism in the gene encoding leucine-rich repeat and immunoglobulin domain–containing protein 1 ( LINGO1 ). Although essential tremor is not medically dangerous, it is progressive and disabling in the home and workplace. 2 The degree of tremor does not always correlate with the severity of disability, 3 and patients with . . .

Peripheral nerve stimulation (PNS) demonstrates promise for some neurological conditions. However, its effectiveness for essential tremor (ET) requires further research. In this randomized, double-blind, sham-controlled trial, we investigated the safety and efficacy of a single, 40-minute PNS session in ET. Eighty-eight participants (age: 63.5 [52.5, 70.3], male: 57.95%) were assigned to active PNS stimulation ( n  = 45) or sham procedure ( n  = 43). Efficacy was assessed using accelerometer-measured tremor amplitude (m/s²), clinician-rated tremor severity using the Tremor Research Group Essential Tremor Rating Assessment Scale (TETRAS), patients’ own experience with daily activities using the Bain and Findley Activities of Daily Living scale (BF-ADL), and their perceived improvement based on the Clinical Global Impression-Improvement scale (CGI-I). Assessments were conducted at baseline, immediately post-stimulation, and at multiple intervals up to 90 min (extending to 24 h for subjective outcomes). Temporal changes in outcomes over time were evaluated using the Generalized Estimating Equation (GEE). The effects of group, time, and their interaction (group*time) on the outcomes were subsequently assessed using GEE. GEE analyses revealed significant group*time interaction for tremor amplitude (B = − 51.61, 95%CI [− 94.60, − 8.62], p  = 0.019). However, no significant group*time interactions were observed for TETRAS, BF-ADL, and CGI-I. This study indicated the effect of PNS on reducing ET amplitude. ID: IRCT20161212031362N2.

The aim of this study was to assess the effects of novel stimulation algorithms of deep brain stimulation (short pulse and directional stimulation) in the ventrointermediate thalamus and posterior subthalamic area (VIM/PSA-DBS) on tremor in Parkinson’s disease (PD) and to compare the effects with those in essential tremor (ET). We recruited six PD patients (70.8 ± 10.4 years) and seven ET patients (64.4 ± 9.9 years) with implanted VIM/PSA-DBS in a stable treatment condition (> 3 months postoperatively). Tremor severity and ataxia were assessed in four different stimulation conditions in a randomized order: DBS switched off (STIM OFF), omnidirectional stimulation with 60 µs (oDBS60), omnidirectional stimulation with 30 µs (oDBS30), directional stimulation at the best segment with 60 µs (dDBS60). In both patient groups, all three DBS stimulation modes reduced the total tremor score compared to STIM OFF, whereas stimulation-induced ataxia was reduced by oDBS30 and partially by dDBS60 compared to oDBS60. Tremor reduction was more pronounced in PD than in ET due to a limited DBS effect on intention and action-specific drawing tremor in ET. In PD and ET tremor, short pulse or directional VIM/PSA-DBS is an effective and well tolerated therapeutic option. Trial registration: The study was registered in the DRKS (ID DRKS00025329, 18.05.2021, German Clinical Trials Register, DRKS—Deutsches Register Klinischer Studien).

Background: Transcutaneous afferent patterned stimulation (TAPS) is a wrist-worn, non-invasive therapy delivering calibrated stimulation to the median and radial nerves. While the efficacy and safety of TAPS therapy for essential tremor (ET) have been demonstrated, current evidence supporting therapeutic benefits of TAPS versus standard of care (SOC) is lacking. This prospective study evaluated the clinical benefit of adding TAPS treatment to SOC versus SOC alone. Methods: This randomized, controlled, pragmatic trial recruited patients from a large health plan’s Commercially Insured and Medicare Advantage population. 310 patients were randomized 1:1 to one month of treatment with TAPS (TX) or standard of care (SOC). The pre-specified endpoints were changes in tremor power measured by motion sensors (primary) and improvement in Bain & Findley Activities of Daily Living (BF-ADL) upper limb scores reported (secondary) between TX and SOC at one month. Results: 276 patients completed the one-month endpoints (n=133 TX, n=143 SOC). The study met the primary and secondary endpoints, with significantly reduced tremor power in TX than SOC (0.017 (0.003) versus 0.08 (0.014) (m/s2)2; geometric mean (SE); p < 0.0001) and greater improvement in the BF-ADL score in TX than SOC (1.6 (0.43) vs 0.2 (0.37) points; mean (SE); p < 0.05). 82% of TX patients experienced tremor improvement from before to after therapy. No serious device-related adverse events were reported. Discussion: This trial demonstrates that TAPS significantly improves tremor power and BF-ADLs in patients with ET compared to SOC over one month of home use. Highlights This study found that TAPS significantly improves tremor power and BF-ADL scores in patients with ET compared to SOC over one month of home use. This real-world study suggests that non-invasive TAPS therapy is a safe and valuable treatment option for patients with ET.

The published prevalence of essential tremor is variable worldwide and lacking in Central Europe. We aimed to estimate its prevalence in Hungary and to explore the locally applied therapeutic approaches. We collected data from the National Health Insurance Fund database and pharmacy database registered between 2010 and 2020. Matching the specified codes of the International Classification of Diseases and the individually tailored combination of interventions, we attempted to exclude Parkinson’s disease and other tremor evoking conditions. We estimated the period prevalence of essential tremor age standardized to the European Standard Population at 378–388/100,000. After excluding patients with possible Parkinsonian syndromes, we found that 36.4% of patients with tremor did not take any medication during the study period. Most of the rest used alprazolam followed by propranolol for the longest period of time; the alprazolam and propranolol combination was the most preferred. Deep brain stimulation and ablative surgery were chosen for less than 0.5% of the patients. Our strict methods probably underestimate the essential tremor prevalence in Hungary, which, however, does not differ considerably from international results. Given the limitations of medication therapy, expanding and improving neurosurgical interventions may help improve the quality of life of patients with essential tremor.

Tremor can be an incapacitating symptom that leads to functional impairment. In patients with Parkinson's disease and in those with essential tremor, pharmacologic treatment often does not adequately control tremor. In patients with multiple sclerosis, intention tremor can add considerably to their disability. Neurosurgical thalamotomy is effective in 73 to 93 percent of patients with incapacitating tremor that is refractory to drug therapy. 1 – 6 However, this procedure is accompanied by permanent complications in 9 to 23 percent of patients with Parkinson's disease or essential tremor 1 , 2 , 5 – 8 and in 16 to 41 percent of patients with multiple sclerosis. 7 , . . .

Purpose: The aim of this study was to investigate how deep brain stimulation (DBS) of the caudal zona incerta (cZi) affects speech intelligibility in persons with essential tremor. Method: Thirty-five participants were evaluated: off stimulation, on chronic stimulation optimized to alleviate tremor, and during unilateral stimulation at increasing amplitude levels. At each stimulation condition, the participants read 10 unique nonsense sentences from the Swedish Test of Intelligibility. Two listeners, blinded to stimulation condition, transcribed all recorded sentences orthographically in a randomized procedure. A mean speech intelligibility score for each patient and stimulation condition was computed, and comparisons were made between scores off and on stimulation. Results: Chronic cZi-DBS had no significant effect on speech intelligibility, and there was no difference in outcome between bilateral and unilateral treatments. During unilateral stimulation at increasing amplitudes, nine participants demonstrated deteriorating speech intelligibility. These nine participants were on average older and had more superior contacts activated during the evaluation compared with the participants without deterioration. Conclusions: Chronic cZi-DBS, optimized for tremor suppression, does not generally affect speech intelligibility in persons with essential tremor. Furthermore, speech intelligibility may be preserved in many individuals, even when stimulated at high amplitudes. Adverse effects of high-amplitude unilateral stimulation observed in this study were associated with stimulation originating from a more superior location, as well as with the participants' age. These results, highlighting age and stimulation location as contributing to speech intelligibility outcomes, were, however, based on a limited number of individuals experiencing adverse effects with high-amplitude stimulation and should, therefore, be interpreted with caution.

Background Propranolol, a nonselective beta‐adrenergic blocker, has long been used as one of the standard treatments for essential tremor (ET). Repetitive transcranial magnetic stimulation (rTMS) has also been used for a long time as a substitution therapy for ET patients. Objective The main aim of this study was to evaluate the antitremor effect of 1‐Hz (low‐frequency) cerebellar rTMS and compare it to the use of propranolol in ET patients. Methods In this single‐blinded, randomized, controlled pilot study, a total of 38 patients with ET were randomized into two groups. One group (n = 20) received 1200 pulses of 1‐Hz rTMS at an intensity of 90% of the resting motor threshold to the bilateral cerebellar region for 10 days. Another group (n = 18) received oral propranolol for 30 days. The initial dose was 30 mg/day, which was increased to 60 mg/day after 5 days, then to 90 mg/day on the 11th day, and continued thereafter for 20 days. The Fahn–Tolosa–Marin (FTM) clinical scale was assessed at baseline and at days 5, 10, and 30 to evaluate tremor severity, specific motor tasks, and functional disability. Results Low‐frequency rTMS of the cerebellum significantly improved tremor severity, specific motor tasks (writing, spiral drawing, and pouring), and FTM total scores on days 10 and 30. Nevertheless, we found no significant difference in functional disability at any point in time (p > .05). There were no statistically significant differences in FTM Part A, Part B, Part C scores and total scores of patients in propranolol group on days 5 and 10 compared with before treatment (p > .05). However, FTM total scores and FTM Part A, Part B, and Part C scores were significantly improved for patients when the dose of propranolol was 90 mg/day on day 30. Our study showed that there was no statistically significant difference in the total FTM scores and FTM Part A, Part B, and Part C scores between rTMS and propranolol on days 5, 10, and 30 (p > .05). Conclusion We conclude that both cerebellar low‐frequency rTMS and propranolol could be effective treatment options for patients with ET, but it is not clear which method is more effective. This paper is the first study to compare the effects of rTMS and medication for ET patients. This will help healthcare providers and ET patients select the best treatment.