Deep brain stimulation for essential tremor

Abstract

Essential tremor is one of the most common movement disorders in adults. Tremor is also among the most difficult movement disorders to treat, control or suppress pharmacologically. Deep Brain Stimulation (DBS) is the most effective therapy for the control of medication resistant distal hand tremor. In this chapter, we define essential tremor clinically and describe the known pathophysiology, epidemiology, genetics and medical treatment options. We then discuss the choices and selection of targets for placing DBS electrodes and review the available literature on efficacy and side effects using ON/OFF DBS improvement as an outcome or pre and post DBS tremor improvement as an outcome. The process of patient selection is described and the basic steps for initial DBS programming and optimization of effect are outlined as an algorithm.