Objective: To compare the quality of life (QOL) and activities of daily living (ADL) of patients with Essential Tremor (ET) and Essential Tremor plus (ET-p) with deep brain stimulation (DBS) of the ventral intermediate nucleus (VIM).

Background: According to the actual tremor classification, ET with symptoms beyond action tremor (e.g., ataxia or dystonia) is classified as ET-p (1). Little is known about the improvement of ADL and QOL in ET-p with VIM-DBS. Preliminary results of our group suggest similar tremor reduction in both groups after VIM-DBS but a higher variance in ET-p (2). To evaluate the influence of VIM-DBS on ADL and QOL in ET-p, we collected data on QOL, ADL, and the state of health in ET and ET-p treated with VIM-DBS.

Method: VIM-stimulated ET and ET-p patients completed the German version (3) of the Quality of Life in Essential Tremor Questionnaire (QUEST) and the Bain and Findley ADL Tremor Scale. The QUEST dimension score (0 to 100) and ADL total score (25 to 125 pts) were assessed, lower scores indicating a better QOL and functionality in ADL. Furthermore, patients self-rated their general health and their QOL on a numeric scale ranging from 0 (worst) to 100 (best). Groups were compared using the Mann-Whitney-U-test, variances were determined via Levene’s test (significance level: p<0.05). The abstract shows preliminary results. An inclusion of 30 patients in total is planned.

Results: Thus far, 13 patients with VIM-DBS participated in the study (ET n=6, ET-P n=7). Self-rated general health state (ET 80.83 ±9.17; ET-p 44.29 ±30.06; p=0.014) and QOL (ET 89.17 ±7.36; ET-p 60.71 ±29.36; p=0.014) were significantly better in ET than in ET-p. The QUEST dimension score (ET 16.3 ±8.78; ET-p 34.58 ±10.38; p=0.234) and ADL total score (ET 33.67 ±9.97; ET-p 52.29 ±25.72; p=0.295) did not differ significantly between both groups. ET-p showed a higher variance in all collected data compared to ET (Levene’s test <0.05 for all analysis).

Conclusion: VIM-stimulated ET-p patients have poorer self-rated QOL and general health than VIM-stimulated ET patients. In contrast, questionnaires (QUEST and ADL score) did not reveal significant differences between ET and ET-p. The great variance in ET-p suggests that there is a subgroup of ET-p that profits less from VIM-DBS. Identifying preoperatively those patients may help to avoid unsatisfying outcome after VIM-DBS.

References: 1. Bhatia KP, Bain P, Bajaj N, Elble RJ, Hallett M, Louis ED, u. a. Consensus Statement on the classification of tremors. from the task force on tremor of the International Parkinson and Movement Disorder Society. Movement Disorders. 33(1):75–87. 2. Steffen JK, Dembek TA, Petry-Schmelzer JN, Reker P, Jergas H, Jost ST, Fink GR, Visser-Vandewalle V, Barbe MT, Is VIM-DBS in essential tremor-plus as effective as in essential tremor? Poster presented on the MDS congress 2019 3. Hopfner F, Nebel A, Lyons KE, Tröster AI, Kuhlenbäumer G, Deuschl G, u. a. Validation of the QUEST for German-speaking countries. International Journal of Neuroscience. 1. Februar 2016;126(2):127–34.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/quality-of-life-in-et-and-et-plus-patients-with-thalamic-deep-brain-stimulation/