Rebound Tremor Frequency as a Potential Diagnostic Marker for Delayed Therapy Escape after Thalamic Deep Brain Stimulation for Essential Tremor—Insights from a Cross-Sectional Study

Brain Sciences, vol. 14, pp. 667

Abstract

Delayed therapy escape (DTE) is frequent after thalamic deep brain stimulation for essential tremor, leading to reduced quality of life, often with ataxic symptoms, and early recognition is challenging. Our goal was to examine whether a low-frequency rebound tremor of the left hand after switching off stimulation is useful as a diagnostic marker for DTE. In this cross-sectional study with additional retrospective analysis, we examined 31 patients with bilateral thalamic DBS ≥ 12 months for essential tremor, using quantitative assessments including video-based motion capture, Fahn–Tolosa–Marin Tremor Rating Scale (FTMTRS), and scale for the assessment and rating of ataxia (SARA). If available, preoperative (preOP) and 12-month postoperative assessments were included in the analysis. Evaluations occurred with DBS activated (ON) and deactivated (OFF). A higher ratio FTMTRS nowON/preOP indicated DTE. Preoperative FTMTRS scores were available for 16 patients, including 5 patients with DTE. The receiver operating characteristic analysis found an area under the curve of 0.86 (p = 0.024) for identification of DTE by low-frequency rebound tremor (i.e., OFF) on the left. In conclusion, it could serve as a potential diagnostic marker.

Authors 9

1. Marvin L. Frommer

   University of Freiburg · University Medical Center Freiburg

   Affiliation as printed

   Department of Stereotactic and Functional Neurosurgery, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg im Breisgau, Germany

2. Isabelle Walz

   University of Freiburg · University Medical Center Freiburg

   Affiliation as printed

   Department of Neurology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg im Breisgau, Germany

   Department of Sport and Sport Science, University of Freiburg, 79106 Freiburg im Breisgau, Germany

3. Franz Aiple

   University of Freiburg · University Medical Center Freiburg

   Affiliation as printed

   IT-Department, Neurocenter, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg im Breisgau, Germany

4. Nils Schröter

   University of Freiburg · University Medical Center Freiburg

   Affiliation as printed

   Department of Neurology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg im Breisgau, Germany

5. Michel Rijntjes

   University of Freiburg · University Medical Center Freiburg

   Affiliation as printed

   Department of Neurology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg im Breisgau, Germany

6. Thomas Prokop

   University of Freiburg · University Medical Center Freiburg

   Affiliation as printed

   Department of Stereotactic and Functional Neurosurgery, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg im Breisgau, Germany

7. Peter Christoph Reinacher Aachen Fraunhofer Institute for Laser Technology (ILT)

   University of Freiburg · Kantonsspital St. Gallen · University Medical Center Freiburg · Fraunhofer Institute for Laser Technology

   Affiliation as printed

   Department of Neurosurgery, Kantonsspital St. Gallen, 9000 St. Gallen, Switzerland

   Department of Stereotactic and Functional Neurosurgery, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg im Breisgau, Germany

   Fraunhofer Institute for Laser Technology (ILT), 52074 Aachen, Germany

8. Volker Arnd Coenen

   University of Freiburg · University Medical Center Freiburg

   Affiliation as printed

   Center for Deep Brain Stimulation, University of Freiburg, 79106 Freiburg im Breisgau, Germany

   Department of Stereotactic and Functional Neurosurgery, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg im Breisgau, Germany

9. Bastian Sajonz corresponding

   University of Freiburg · University Medical Center Freiburg

   Affiliation as printed

   Department of Stereotactic and Functional Neurosurgery, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg im Breisgau, Germany