Overview
This will be a single center (OHSU) proof of concept trial to demonstrate that directional deep brain stimulation (DBS) creates a larger therapeutic window for the treatment of essential tremor (ET), effectively treats ET, and minimizes effects on speech, gait and balance compared to nondirectional DBS.
Description
Specific Aims:
- To compare the therapeutic window (TW) of directional versus nondirectional deep brain stimulation for treatment of tremor.
Hypothesis: directional DBS will result in a wider TW than nondirectional DBS.
2. To compare the effects of directional versus nondirectional DBS on speech Hypothesis: Objective and subjective speech impairment will occur to a greater extent in nondirectional DBS versus directional DBS optimized for tremor control.
3. To compare the effects of directional versus nondirectional DBS on balance and gait Hypothesis: Objective and subjective balance and gait impairment will occur to a greater extent in nondirectional DBS versus directional DBS optimized for tremor control.
4. To assess efficacy for tremor of nondirectional and directional DBS in an optimized programming configuration Hypothesis: both directional and nondirectional DBS will significantly improve tremor compared to baseline.
Eligibility
Inclusion Criteria:
- A tremor syndrome of bilateral upper limb action tremor with at least 3 years' duration
Exclusion Criteria:
- Patients who have decided not to receive DBS for control of their medication-refractory essential tremor.
- Patients with secondary tremor (ie not Essential Tremor), such as side effects from medications, secondary to another identified neurologic disease (eg multiple sclerosis, -----Parkinson's disease, dystonia).
- Prior history of deep brain stimulation.
- Prior history of thalamotomy.
- A history or signs of dystonia, ataxia or parkinsonism.
- Task specific tremor.
- Orthostatic tremor.
- Patients with cardiac pacemakers, defibrillators, or neurostimulators.
- Patients who require MRI, ECT, rTMS, or diathermy.
- Subjects with other type of neurological disease or injury.