Editing Deep brain stimulation (section)

=== Essential tremor ===
[[File:VIM of thalamus diagram.jpg|thumb|Ventrointermediate nucleus of the thalamus, the target nucleus for essential and Parkinson's tremor.]]
Essential tremor, the most common movement disorder, is a chronic condition characterized by involuntary and rhythmic shaking.<ref>{{Cite web |title=Essential Tremor: Essential Facts for Patients |url=https://www.movementdisorders.org/MDS/Resources/Patient-Education/Essential-Tremor.htm |access-date=2024-09-22 |website=www.movementdisorders.org}}</ref> It was the first indication to be approved for DBS (alongside Parkinsonian tremor) and before DBS had a long history of being treated with ablative brain lesioning.<ref>{{Cite journal |last1=Neudorfer |first1=Clemens |last2=Kultas-Ilinsky |first2=Kristy |last3=Ilinsky |first3=Igor |last4=Paschen |first4=Steffen |last5=Helmers |first5=Ann-Kristin |last6=Cosgrove |first6=G. Rees |last7=Richardson |first7=R. Mark |last8=Horn |first8=Andreas |last9=Deuschl |first9=Günther |date=April 2024 |title=The role of the motor thalamus in deep brain stimulation for essential tremor |journal=Neurotherapeutics |language=en |volume=21 |issue=3 |pages=e00313 |doi=10.1016/j.neurot.2023.e00313 |pmc=11103222 |pmid=38195310}}</ref>

Frequencies above 100&nbsp;Hz are most effective for cessation of tremor, while lower frequencies have less effect.<ref>{{Cite journal |last1=Benabid |first1=A.L. |last2=Pollak |first2=P. |date=February 1991 |title=Long-term suppression of tremor by chronic stimulation of the ventral intermediate thalamic nucleus |url=https://linkinghub.elsevier.com/retrieve/pii/014067369191175T |journal=The Lancet |language=en |volume=337 |issue=8738 |pages=403–406 |doi=10.1016/0140-6736(91)91175-T |pmid=1671433|url-access=subscription }}</ref> In clinical practice, frequencies between 80 and 180&nbsp;Hz are typically applied. DBS electrodes commonly target the ventrointermediate nucleus of the thalamus (VIM) or ventrally adjacent areas in the [[zona incerta]] or posterior thalamus. Multiple targets along the circuitry of the cerebellothalamic pathway (also referred to as the dentatorubrothalamic or dentatothalamic tract) have been shown to have similar therapeutic effect.<ref>{{Cite journal |last1=Nowacki |first1=Andreas |date=May 2022 |title=Probabilistic Mapping Reveals Optimal Stimulation Site in Essential Tremor |url=https://onlinelibrary.wiley.com/doi/10.1002/ana.26324 |journal=Annals of Neurology |language=en |volume=91 |issue=5 |pages=602–612 |doi=10.1002/ana.26324 |pmid=35150172 |issn=0364-5134}}</ref><ref>{{Cite journal |last1=Neudorfer |first1=Clemens |date=May 2022 |title=Personalizing Deep Brain Stimulation Using Advanced Imaging Sequences |url=https://onlinelibrary.wiley.com/doi/10.1002/ana.26326 |journal=Annals of Neurology |language=en |volume=91 |issue=5 |pages=613–628 |doi=10.1002/ana.26326 |pmid=35165921 |issn=0364-5134}}</ref><ref>{{Cite journal |last1=Fox |first1=Michael D. |last2=Deuschl |first2=Günther |date=May 2022 |title=Converging on a Neuromodulation Target for Tremor |url=https://onlinelibrary.wiley.com/doi/10.1002/ana.26361 |journal=Annals of Neurology |language=en |volume=91 |issue=5 |pages=581–584 |doi=10.1002/ana.26361 |pmid=35362142 |issn=0364-5134|url-access=subscription }}</ref>

Possible side effects of DBS for essential tremor include speech difficulties and paresthesia. Similar targets have previously been applied to treat essential tremor using surgical lesioning, for instance using [[HIFU|MR-guided Focused Ultrasound]], [[Radiosurgery|Gamma-Knife Radiosurgery]] or conventional [[Radiofrequency ablation|radiofrequency lesioning]]. The annual volume of [[MRgFUS]] [[thalamotomy|thalamotomies]] has overtaken DBS for treatment of tremor.<ref>{{Cite journal |last1=Joutsa |first1=Juho |last2=Lipsman |first2=Nir |last3=Horn |first3=Andreas |last4=Cosgrove |first4=G Rees |last5=Fox |first5=Michael D |date=2023-08-01 |title=The return of the lesion for localization and therapy |url=https://academic.oup.com/brain/article/146/8/3146/7114971 |journal=Brain |language=en |volume=146 |issue=8 |pages=3146–3155 |doi=10.1093/brain/awad123 |issn=0006-8950 |pmc=10393408 |pmid=37040563}}</ref>