Peripheral Nerve Stimulation May Improve Essential Tremor

Essential tremor is common, seen in 1 in ten people over the age of 70 but it can start in the teens in those genetically predisposed. It can be disabling and is difficult to treat. At best, “symptomatic” medications such as beta-blockers, primidone, and topiramate/zonisamide, may improve severity by half.

Combination treatment may be necessary and side effects are common and can be intolerable. Deep brain stimulation is usually very effective but is obviously invasive. There are infrequent but potentially serious risks.

Jack Florin, MD — Your Neurologist in Orange County.

A new approach would be welcome and, in fact, a noninvasive device was presented at the 2018 Annual Meeting of the AAN. It is worn on the wrist and at-home monitoring is available. It delivers electrical stimulation the median and radial nerves and adjusts to the patient’s tremor frequency. It seems well-tolerated.

In the study reported, two 40- minute treatment sessions were done each day for two weeks. The active treatment group was compared to a “blinded” sham treatment group and an unblinded standard-of-care group. The treated group improved by 65% compared to 32% for the other groups.

The device was developed by Cala Health, will be marketed as Cala ONE, and was FDA-approved on April 26, 2018.

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