Objective: To review clinical characteristics of essential tremor (ET) in patients who underwent deep brain stimulation (DBS) surgery.

Background: DBS surgery is an effective treatment for patients with refractory ET. There has been an improvement in the surgical and programming technique over time. However, only a minority of patients with ET undergo DBS. We conducted a retrospective review of clinical characteristics of ET in patients who underwent DBS, to develop a better understanding of factors that may play an important role in the selection for this procedure.

Method: The Movement Disorders Clinical Case Registry at Parkinson Disease Research, Education and Clinical Center (PADRECC), Houston, was queried for patients with ICD-9 or 10 diagnostic codes of ET. Subjects were seen in PADRECC from September 1, 2001 – March 31, 2018. Charts were reviewed to verify the diagnosis of ET and surgery for DBS. Clinical data was abstracted from the records meeting the inclusion criteria.

Results: Of 1468 patients with at least one of the codes, 1051 (71.6%) had evidence of ET in the EMR, including information on treatment provided. Of the 1051 patients identified with ET, 42 (3.99%) were treated with DBS for medically refractory tremor. Within this male dominant cohort (100%) of 42 patients, mean age at onset of symptoms was 38.7±17.91, diagnosis occurring at mean age of 59.9± 12.6, and patients undergoing DBS at 68.4 years±7.8. Family history was positive in 64.10% of patients (n=25) while alcohol responsiveness was reported in 28.57% of the cohort (n=8). 68.57% of patients had head tremor (n=24). 57.14% of patients reported predominant tremor in the right hand (n=20), 22.85% had left predominant tremor (n=8) while 20% patient reported similar tremor on both sides (n=7). 67.64% patients were noted to have gait impairment (n=23). Most affected task was handwriting (n=17). Average number of medications taken before DBS surgery were 2.94 with a median of 3.0. Thirty percent (n=11) of patients received botulinum toxin surgery prior to undergoing DBS surgery.

Conclusion: This data identifies some of the key features of a cohort of military veterans with ET who underwent DBS surgery. The clinical significance of these features with respect to patient selection for DBS surgery remains to be defined.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/deep-brain-stimulation-surgery-and-clinical-characteristics-of-essential-tremor-in-a-cohort-of-veterans/