Objective: The aim of this study was to investigate differential and synergistic effects of short pulse and directional deep brain stimulation in the ventral intermediate thalamus (VIM) / posterior subthalamic area (PSA) on tremor and stimulation-induced side effects in patients with essential tremor.

Background: Novel deep brain stimulation modes like directional and short-pulse stimulation can reduce side effects and widen the therapeutic window, but potential synergistic effects have not been investigated, so far.

Method: We recruited eleven patients with essential tremor and VIM/PSA-DBS.  Tremor severity (Fahn-Tolosa-Marin), ataxia (ICARS) and paresthesia (VAS) were assessed with conventional omnidirectional and directional stimulation with pulse width of 60µs and 30µs.

Results: All stimulation conditions reduced tremor. The best directional stimulation with 30µs reduced more tremor compared with most other stimulation settings. The best directional stimulation regardless of pulse width effectively reduced stimulation-induced ataxia compared with the worst directional stimulation with 60µs. Only the best directional stimulation with 30µs attenuated paresthesia. The best directional stimulation with 30µs reduced tremor, ataxia and paresthesia compared with conventional stimulation in the majority of patients.

Conclusion: A combination of directional and short pulse stimulation revealed synergistic beneficial effects on tremor suppression and stimulation-induced adverse effects.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/synergistic-effects-of-short-pulse-and-directional-deep-brain-stimulation-of-the-thalamic-ventral-intermediate-area-for-essential-tremor/