Effects of DBS on precision grip abnormalities in essential tremor

Deep brain stimulation (DBS) of the ventrolateral thalamus is a highly effective procedure for the treatment of essential tremor (ET). The regularity of repetitive, self-paced finger tapping is known to be abnormal in patients with ET and improved following DBS. However, the more complex timing that underlies force development in the hands in ET and after DBS has not been evaluated. In this pilot study, we assessed precision grip performance in seven ET subjects before and after 5 months of DBS. Ten healthy controls were also studied. ET subjects showed a significant increase in preload duration (235 +/- A 145 vs. 82 +/- A 49 ms) and peak negative load (-0.524 +/- A 0.35 vs. -0.174 +/- A 0.14 N) during grip-lift compared with healthy subjects. No difference in load duration was observed between the groups. Following DBS, the magnitude of the peak negative load was significantly reduced (P = 0.03). In contrast, the duration of the load phase was worsened (non-significant) after DBS. We conclude that defects in the control of distal musculature necessary for establishing a stable grip exist in ET, whereas proximal muscles necessary for object lift-off remain relatively intact. Further, synergy paradigms governing grip-lift coordination may also be impaired. Although DBS is successful in alleviating tremor in ET, it produces only a partial restoration of normal precision grip.