Deep Brain Stimulation for Tremor in Parkinson’s Disease

Rest tremor, muscular rigidity, and bradykinesia are the cardinal features of Parkinson’s disease (PD). Rest tremor is present in over 70% of patients with PD, and, in most cases, occurs early in the course of the disease. Two subtypes of tremor-related PD have been described: tremor-predominant PD and benign tremulous Parkinsonism. In both cases the tremor may be poorly responsive to levodopa and other medications and significantly impact activities of daily living and quality of life. These patients are excellent candidates for deep brain stimulation (DBS). In this chapter, we describe a tremor-predominant patient who responded well to subthalamic nucleus (STN) DBS. We discuss the use of the STN and thalamic targets for DBS.