Peripheral Nerve Stimulation for Essential Tremor: a Systematic Review and Meta-Analysis of Effectiveness and Safety.
Mohamed El-Moslemani, Abdallah Abbas, Haneen Sabet et al.
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In 30 seconds
This systematic review and meta-analysis assessed peripheral nerve stimulation (PNS), including transcutaneous afferent patterned stimulation and transcutaneous peripheral nerve stimulation, for essential tremor. Across 19 studies involving 2,541 patients, sham-controlled analyses found improved TETRAS performance scores (MD = - 1.00; p = 0.002) and functional disability scores (BF-ADL MD = - 1.69; p < 0.0001). Findings for tremor amplitude and total TETRAS were inconsistent, and the pooled total TETRAS estimate was not statistically significant. Reported adverse events were mostly mild and transient, with no serious events attributed to PNS.
Key findings
- Sham-controlled TETRAS performance scores improved with PNS (MD = - 1.00; p = 0.002; I 2 = 0%).
- BF-ADL scores improved in sham-controlled analyses (MD = - 1.69; p < 0.0001) and single-arm pre-post analyses (MD = - 3.22; p < 0.0001).
- Tremor amplitude and total TETRAS results were inconsistent; the pooled total TETRAS estimate was not statistically significant (p = 0.16).
- Skin irritation was the most frequently reported adverse event (7.88%); no serious adverse events were attributed to PNS.
Why it matters
PNS may offer a non-invasive option associated with functional improvement and generally mild reported adverse events in essential tremor. The distinction between functional outcomes and inconsistent tremor-severity measures is important when interpreting potential benefit. These findings may inform consideration of PNS alongside existing approaches, while the evidence does not establish uniform improvement across measured tremor outcomes.
What to keep in mind
Results for tremor amplitude and total TETRAS were inconsistent, with high heterogeneity (I 2 up to 94%), driven mainly by differences in assessment timing.