Deep Brain Stimulation in Tremor

Deep brain stimulation (DBS) is a non‐destructive, reversible, and programmable method of treating a number of neurologic and psychiatric conditions, including tremor. Stimulation of the ventral intermediate nucleus (Vim) of the thalamus for the treatment of essential tremor (ET) and parkinsonian tremor was given approval by the Food and Drug Administration (FDA) in 1997. Nowadays, parkinsonian tremor is more commonly treated by stimulating the subthalamic nucleus (STN) and globus pallidus pars interna (GPi). Tremor associated with multiple sclerosis (MS) can also be treated with thalamic stimulation. The exact means by which DBS works in tremor is not known, although it is thought that the various movement disorders and psychiatric disorders treated with DBS represent states of disordered neurophysiologic circuitry. Fundamentally, though, the success of DBS depends largely on patient selection, reasonable expectations, preoperative surgical planning, precise surgical implantation, tailored programming, and careful long‐term management.