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(55) Pathway Activation Differences in Treating Kinetic versus Postural Tremor with Deep Brain Stimulation

Friday, June 13, 2025
5:10 PM - 5:50 PM ET
Location: Sky View
Introduction: Essential Tremor, one of the most prevalent movement disorders, presents as an action tremor in the bilateral upper extremities. It is present in about 1% of the population worldwide across all ages, and increases to a prevalence of 5.8% in populations of individuals 65 years and older1. Individuals with Essential Tremor typically have two types of upper extremity action tremors, postural (ability to voluntarily maintain the hold against gravity) and kinetic (voluntary movement)2. Kinetic tremors, compared to postural tremors, are more difficult to suppress with deep brain stimulation (DBS) in patients with Essential Tremor3–8. While the cerebellothalamic tract (CTT) has been proposed as the optimal target for tremor suppression, specific neural pathway associations with postural and kinetic tremor reduction have not yet been identified9.

Methods: In this study, we developed high-dimensional, subject-specific pathway activation models of 20 directional DBS leads using ultra-high field (7T) preoperative MR and postoperative CT imaging for 11 patients with Essential Tremor. Predicted pathway activations of six parcellated regions of the CTT, five parcellated regions of the zona incerta (ZI), and seven other pathways around the ventral intermediate nucleus (VIM) of thalamus were computed for two stimulation thresholds each at 10 monopolar configurations per patient. Mixed-effect models were utilized to determine how pathway associations contributed to quantitative inertial measurements of tremor suppression across three postures (forward outstretched, wing beating, and dot approximation) and three voluntary (kinetic) movement tasks (finger-nose-finger, handwriting, and spiral).

Results: Postural tremors demonstrated a significant reduction in amplitude and standard deviation and significant increase in frequency compared to kinetic tremors in response to monopolar DBS settings. Additionally, the strongest improvement in specific tasks (postural and kinetic) aligned with targeting the CTT and ZI pathways to different extents.

Conclusion: Utilizing this personalized, therapeutic approach will help clinicians more accurately target pathways in the brain for action tremors and, ultimately, provide patients with better outcomes.