Abstract
Pathological tremors are involuntary oscillatory movements which cannot be fully attenuated using conventional treatments. For this reason, several studies have investigated the use of neuromuscular electrical stimulation for tremor suppression. In a recent study, however, we found that electrical stimulation below the motor threshold also suppressed tremor, indicating involvement of afferent pathways. In this study, we further explored this possibility by systematically investigating how tremor suppression by afferent stimulation depends on the stimulation settings. In this way, we aimed at identifying the optimal stimulation strategy, as well as to elucidate the underlying physiological mechanisms of tremor suppression. Stimulation strategies varying the stimulation intensity and pulse timing were tested in nine tremor patients using either intramuscular or surface stimulation. Significant tremor suppression was observed in six patients (tremor suppression > 75% was observed in three patients) and the average optimal suppression level observed across all subjects was 52%. The efficiency for each stimulation setting, however, varied substantially across patients and it was not possible to identify a single set of stimulation parameters that yielded positive results in all patients. For example, tremor suppression was achieved both with stimulation delivered in an out-of-phase pattern with respect to the tremor, and with random timing of the stimulation. Overall, these results indicate that low-current stimulation of afferent fibers is a promising approach for tremor suppression, but that further research is required to identify how the effect can be maximized in the individual patient.
Highlights
Pathological tremors are involuntary, rhythmical movements of a body part and are symptomatic of several neurological disorders including Parkinson’s Disease (PD) and Essential Tremor (ET) (Elble, 2009)
That arises due to burst-like muscle activity patterns (Deuschl et al, 1987), is among the most prevalent movement disorders and can partly or Tremor Suppression by Afferent Stimulation completely impair the execution of natural motor tasks (Wenning et al, 2005)
We investigated suppression of pathological tremor through stimulation of afferent fibers
Summary
Pathological tremors ( referred to as tremor) are involuntary, rhythmical movements of a body part and are symptomatic of several neurological disorders including Parkinson’s Disease (PD) and Essential Tremor (ET) (Elble, 2009). Standard treatment includes medication (Lyons and Pahwa, 2008), neurosurgery (Kondziolka et al, 2008), or deep brain stimulation (Kalia et al, 2013). Such treatments, can be invasive, expensive, and may not produce effective, long-lasting tremor suppression tremor for all patients. The efficacy of both methodologies has been proven, electrical stimulation arguably allows for a more compact and comfortable implementation. Both of these factors are considered critical for minimizing user rejection of orthotic devices (Biddiss and Chau, 2007)
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