No Additional Benefit of 185 Hz Versus 130 Hz at Equivalent Energy in Deep Brain Stimulation for Tremor: A Randomized Prospective Clinical Trial.
4 affiliations
- 1Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
- 2Department of Neurology with Experimental Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany.
- 3Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM3)-Research Center Jülich, Jülich, Germany.
- 4Department of Stereotactic and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
Abstract
Background
Deep brain stimulation (DBS) of the ventral intermediate nucleus and posterior subthalamic area (VIM/PSA) in Essential Tremor (ET) and the subthalamic nucleus (STN) in Parkinson's disease (PD) are established treatments for tremor. To achieve maximum tremor control, increasing stimulation frequency beyond 130 Hz is part of clinical practice, but lacks scientific evidence.Objective
To compare tremor suppression under total electrical energy delivered (TEED)-equivalent stimulation at 130 versus 185 Hz in VIM/PSA-DBS for ET and STN-DBS for PD.Methods
In this prospective, double-blind study, acute DBS effects were assessed in 18 people with ET (n = 29 hemispheres), and 25 people with PD (n = 30 hemispheres). Tremor-suppressive effects, evaluated by accelerometry, were compared with TEED-equivalent stimulation at 130 and 185 Hz using linear mixed-effects models, explorative pairwise comparisons, and equivalency testing.Results
Linear mixed-effects models revealed no significant effect of stimulation frequency on tremor improvement in both cohorts. Pairwise comparisons showed no consistent differences in total tremor improvement with TEED-equivalent 130 Hz vs 185 Hz DBS. Post-hoc equivalence testing confirmed equivalence of stimulation frequencies under TEED-equivalent conditions within a ±20% margin of relative tremor improvement.Conclusion
This study provides Level II evidence that a higher stimulation frequency of 185 Hz does not offer additional benefit in deep brain stimulation for tremor in VIM/PSA for Essential Tremor or in the STN for Parkinson's Disease in the acute setting and supports 130 Hz as the standard stimulation frequency for tremor suppression.
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BibTeX
@article{linden2026additional,
title = {{No Additional Benefit of 185 Hz Versus 130 Hz at Equivalent Energy in Deep Brain Stimulation for Tremor: A Randomized Prospective Clinical Trial.}},
author = {Christina van der Linden and Peer Trapp and Till A Dembek and Charlotte Schedlich-Teufer and Gregor A Brandt and Hannah Jergas and Gereon R Fink and Veerle Visser-Vandewalle and Michael T Barbe and Jan Niklas Petry-Schmelzer},
journal = {Movement disorders clinical practice},
year = {2026},
month = nov,
doi = {10.1002/mdc3.70886},
url = {https://europepmc.org/article/MED/42972941},
note = {CC BY},
}
RIS
TY - JOUR
TI - No Additional Benefit of 185 Hz Versus 130 Hz at Equivalent Energy in Deep Brain Stimulation for Tremor: A Randomized Prospective Clinical Trial.
AU - Christina van der Linden
AU - Peer Trapp
AU - Till A Dembek
AU - Charlotte Schedlich-Teufer
AU - Gregor A Brandt
AU - Hannah Jergas
AU - Gereon R Fink
AU - Veerle Visser-Vandewalle
AU - Michael T Barbe
AU - Jan Niklas Petry-Schmelzer
PY - 2026
DA - 2026/11/02
JO - Movement disorders clinical practice
DO - 10.1002/mdc3.70886
UR - https://europepmc.org/article/MED/42972941
AB - Background Deep brain stimulation (DBS) of the ventral intermediate nucleus and posterior subthalamic area (VIM/PSA) in Essential Tremor (ET) and the subthalamic nucleus (STN) in Parkinson's disease (PD) are established treatments for tremor. To achieve maximum tremor control, increasing stimulation frequency beyond 130 Hz is part of clinical practice, but lacks scientific evidence.Objective To compare tremor suppression under total electrical energy delivered (TEED)-equivalent stimulation at 130 versus 185 Hz in VIM/PSA-DBS for ET and STN-DBS for PD.Methods In this prospective, double-blind study, acute DBS effects were assessed in 18 people with ET (n = 29 hemispheres), and 25 people with PD (n = 30 hemispheres). Tremor-suppressive effects, evaluated by accelerometry, were compared with TEED-equivalent stimulation at 130 and 185 Hz using linear mixed-effects models, explorative pairwise comparisons, and equivalency testing.Results Linear mixed-effects models revealed no significant effect of stimulation frequency on tremor improvement in both cohorts. Pairwise comparisons showed no consistent differences in total tremor improvement with TEED-equivalent 130 Hz vs 185 Hz DBS. Post-hoc equivalence testing confirmed equivalence of stimulation frequencies under TEED-equivalent conditions within a ±20% margin of relative tremor improvement.Conclusion This study provides Level II evidence that a higher stimulation frequency of 185 Hz does not offer additional benefit in deep brain stimulation for tremor in VIM/PSA for Essential Tremor or in the STN for Parkinson's Disease in the acute setting and supports 130 Hz as the standard stimulation frequency for tremor suppression.
SN - 2330-1619
ER -