• Michael T Barbe, Paul Reker, Stefanie Hamacher, Jeremy Franklin, Daria Kraus, Till A Dembek, Johannes Becker, Julia K Steffen, Niels Allert, Jochen Wirths, Haidar S Dafsari, Jürgen Voges, Gereon R Fink, Veerle Visser-Vandewalle, and Lars Timmermann.
• From the Department of Neurology (M.T.B., P.R., T.A.D., J.B., J.K.S., H.S.D., G.R.F., L.T.) and Department of Stereotaxy and Functional Neurosurgery (T.A.D., J.W., V.V.-V.), University Hospital of Cologne; Institute of Medical Statistics and Computational Biology (S.H., J.F.) and Clinical Trials Center Cologne (D.K.), University of Cologne; Neurological Rehabilitation Center Godeshöhe (N.A.), Bonn, Germany; National Parkinson Foundation International Centre of Excellence (H.S.D.), Kings College Hospital, London, UK; Department of Stereotactic Neurosurgery (J.V.), Otto-von-Guericke University Magdeburg and Leibniz Institute for Neurobiology; Cognitive Neuroscience (G.R.F.), Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich; and Department of Neurology (L.T.), University Hospital Marburg, Germany michael.barbe@uk-koeln.de.
• Neurology. 2018 Aug 7; 91 (6): e543-e550.

ObjectiveTo evaluate deep brain stimulation (DBS) of the posterior subthalamic area (PSA) in essential tremor (ET) and compare it to the ventral intermediate nucleus of the thalamus (VIM) in terms of stimulation efficacy, efficiency, and side effects.MethodsDBS leads were implanted such that contacts were placed in the VIM, on the intercommissural line, and in the PSA. Thirteen patients with ET entered a randomized, double-blind crossover phase and completed a 1-year follow-up.ResultsPSA-DBS significantly reduced tremor severity and improved quality of life. There were no relevant differences in quality and frequency of stimulation side effects between VIM and PSA, with a tendency toward greater tremor improvement with PSA stimulation. Clinical benefit was achieved at significantly lower stimulation amplitudes in the PSA. The majority of patients remained with PSA-DBS after 1 year.ConclusionIn accordance with previous retrospective investigations, our prospective data suggest that PSA-DBS is at least equally effective as but possibly more efficient than VIM-DBS.Classification Of EvidenceThis study provides Class I evidence that for patients with essential tremor, PSA-DBS is not significantly different from VIM-DBS in suppressing tremor, but clinical benefit from PSA-DBS is attained at lower stimulation amplitudes.© 2018 American Academy of Neurology.

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