About this Research Topic
Tremor is one of the most common movement disorders. It appears as an involuntary, rhythmic, and oscillatory movement involving one or more body parts. Around 70% of Parkinson’s disease (PD) patients present tremor, that is generally asymmetric, affects the upper limbs and extremities, and is suppressed during voluntary movements. The most common PD tremor is the resting tremor. Tremor in PD is mainly due to the depletion of dopaminergic neurons in the substantia nigra.
Pharmacological interventions such as treatment with levodopa and carbidopa are used to counteract dopamine depletion and the resulting motor dysfunction in PD patients. Yet there is still no full consensus on the effective remission of the motor dysfunction following pharmacological treatment and there is evidence of some treatment-resistant cases.
Alongside pharmacological treatment and ongoing trials for pharmacological alternatives, deep brain stimulation (DBS) appears to be a promising treatment in patients with PD tremor.
DBS was reported as effective in improving motor and non-motor PD-related symptoms. It is an invasive form of intervention however and requires brain surgery. This procedure therefore requires an appropriate and carefully designed surgical protocol/workflow which takes patient-specific risk-benefit analysis into account.
When planning surgery and DBS intervention, practitioners must carry out an in-depth risk pre-evaluation, target identification (internal globus pallidus or the subthalamic nucleus), evaluation of unilateral or bilateral stimulation, together with a cognitive risk evaluation, just to mention a few.
To overcome surgical risks associated with implantation, non-invasive brain stimulation (NIBS) techniques such as transcranial electric stimulation (tES) are increasingly adopted to treat PD tremors. The technique helps to modulate the underlying abnormally functioning networks. Nevertheless, recent studies have reported variability in efficacy. Hence, further investigation and refinement are necessary.
Other non-invasive methods such as peripheral nerve electrical stimulation (PES) and functional electrical stimulation (FES) have also proved effective in reducing tremor.
All these stimulation alternatives are currently being adopted thanks to their non-invasive, easy-to-use, and economic nature. To improve their functional outcome, further evidence on their clinical efficacy and a deeper understanding of the underlying mechanisms are needed.
This Research Topic will spotlight recent advances and current knowledge on DBS and other non-invasive electrical stimulation approaches adopted to suppress or reduce tremors not only in PD patients, but also in patients with essential tremor (ET).
Our objective is to gather further insights on the clinical outcomes of tremor alleviation using non-pharmacological methodologies. This technique either can stand alone or be adjuvant to conventional PD pharmacological therapies. The focus should be dedicated to stimulation approaches, methodologies, experimental designs, and clinical outcomes
We welcome submissions addressing the following:
· Insights on PD tremor pathophysiology
· Technological advances improving DBS results in tremor
· Evidence ET and PD tremor treated through stimulation
· PES and FES
· DBS: comparison between Subthalamic nucleus stimulation vs internal globus pallidus stimulation, in terms of target efficacy
· Optimized DBS and NIBS workflows and stimulation protocols, including advances in wearable stimulation devices
Pharmacological interventions such as treatment with levodopa and carbidopa are used to counteract dopamine depletion and the resulting motor dysfunction in PD patients. Yet there is still no full consensus on the effective remission of the motor dysfunction following pharmacological treatment and there is evidence of some treatment-resistant cases.
Alongside pharmacological treatment and ongoing trials for pharmacological alternatives, deep brain stimulation (DBS) appears to be a promising treatment in patients with PD tremor.
DBS was reported as effective in improving motor and non-motor PD-related symptoms. It is an invasive form of intervention however and requires brain surgery. This procedure therefore requires an appropriate and carefully designed surgical protocol/workflow which takes patient-specific risk-benefit analysis into account.
When planning surgery and DBS intervention, practitioners must carry out an in-depth risk pre-evaluation, target identification (internal globus pallidus or the subthalamic nucleus), evaluation of unilateral or bilateral stimulation, together with a cognitive risk evaluation, just to mention a few.
To overcome surgical risks associated with implantation, non-invasive brain stimulation (NIBS) techniques such as transcranial electric stimulation (tES) are increasingly adopted to treat PD tremors. The technique helps to modulate the underlying abnormally functioning networks. Nevertheless, recent studies have reported variability in efficacy. Hence, further investigation and refinement are necessary.
Other non-invasive methods such as peripheral nerve electrical stimulation (PES) and functional electrical stimulation (FES) have also proved effective in reducing tremor.
All these stimulation alternatives are currently being adopted thanks to their non-invasive, easy-to-use, and economic nature. To improve their functional outcome, further evidence on their clinical efficacy and a deeper understanding of the underlying mechanisms are needed.
This Research Topic will spotlight recent advances and current knowledge on DBS and other non-invasive electrical stimulation approaches adopted to suppress or reduce tremors not only in PD patients, but also in patients with essential tremor (ET).
Our objective is to gather further insights on the clinical outcomes of tremor alleviation using non-pharmacological methodologies. This technique either can stand alone or be adjuvant to conventional PD pharmacological therapies. The focus should be dedicated to stimulation approaches, methodologies, experimental designs, and clinical outcomes
We welcome submissions addressing the following:
· Insights on PD tremor pathophysiology
· Technological advances improving DBS results in tremor
· Evidence ET and PD tremor treated through stimulation
· PES and FES
· DBS: comparison between Subthalamic nucleus stimulation vs internal globus pallidus stimulation, in terms of target efficacy
· Optimized DBS and NIBS workflows and stimulation protocols, including advances in wearable stimulation devices
Keywords: deep brain stimulation, non invasive brain stimulation, protocols, subthalamic nuclesu, internal globus pallidus, tremors, essential tremor, Pardkinson's Disease, movement disorders
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