Microlesion effects, suboptimal lead placement and disease progression are critical determinants for DBS tolerance in essential tremor

Merchant et al. propose a computerized spiral analysis test for differentiation of essential tremor (ET) patients who develop "early tolerance" to deep brain stimulation (DBS) benefits (within two years) from those who exhibit sustained improvements (Merchant et al., 2018). In their study, ET patients were identified to develop "early tolerance" if they had a higher degree of severity score and a greater loop-to-loop width variability index on spiral drawings. The latter characteristic is usually observed in patients with underlying cerebellar dysfunction.

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