Abstract
Spinal cord stimulation (SCS) and deep-brain stimulation reportedly improve refractory orthostatic tremor (OT). No comparative data exist assessing subperceptional versus perceptional SCS with sham stimulation in patients with OT. Two patients who had refractory OT were assessed at baseline and 3 months after SCS implantation using 3 different SCS modes: paraesthesia-free burst SCS (40 Hz), sham SCS, and paraesthesia-evoking tonic SCS (100-130 Hz). Surface electromyography, standing time, stimulation parameters, and any adverse events were prospectively recorded. Improved standing time was observed under burst and tonic mode versus stimulation off and compared with baseline in both patients (patient 1: baseline = 22-second; burst SCS [subperceptional]/ standing time = 2.8 minutes; stimulation off/ standing time = 28 seconds; and tonic SCS [perceptional]/ standing time = 1.2 minutes; patient 2: baseline = 47-second; burst SCS [subperceptional]/ standing time = 3.1 minutes; stimulation off/ standing time = 48 seconds; and tonic SCS [perceptional]/ standing time = 1.1 minute). The electromyography frequency demonstrated a decline in tremor frequency. Burst as a novel SCS paradigm may be co-considered in patients with refractory OT before more invasive deep-brain stimulation.
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