Highlights
- •Resting tremor in PD can be intractable, not responding to dopaminergic drugs.
- •The exact mechanism of peripheral mechanism in tremor modulation is not clear.
- •In our study, electrical muscle stimulation can attenuate tremor temporarily.
- •Although tremor severity decreased, they continued with a similar frequency.
Abstract
Background
As the pathophysiology of tremor in Parkinson disease (PD) involves a complex interaction
between central and peripheral mechanisms, we propose that modulation of peripheral
reflex mechanism by electrical muscle stimulation (EMS) may improve tremor temporarily.
Objectives
To determine the efficacy of EMS as a treatment for drug resistant tremor in PD patients.
Methods
This study was a single-blinded, quasi-experimental study involving 34 PD patients
with classic resting tremor as confirmed by tremor analysis. The EMS was given at
50 Hz over the abductor pollicis brevis and interrosseus muscles for 10 s with identified tremor parameters before and during stimulation as primary outcomes.
Results
Compared to before stimulation, we observed a significant reduction in the root mean
square (RMS) of the angular velocity (p < 0.001) and peak magnitude (p < 0.001) of resting tremor while tremor frequency (p = 0.126) and dispersion (p = 0.284) remained unchanged during stimulation. The UPDRS tremor score decreased from
10.59 (SD = 1.74) before stimulation to 8.85 (SD = 2.19) during stimulation (p < 0.001). The average percentage of improvement of the peak magnitude and RMS angular
velocity was 49.57% (SD = 38.89) and 43.81% (SD = 33.15) respectively. 70.6% and 61.8% of patients experienced at least 30% tremor attenuation
as calculated from the peak magnitude and RMS angular velocity respectively.
Conclusions
Our study demonstrated the efficacy of EMS in temporarily improving resting tremor
in medically intractable PD patients. Although tremor severity decreased, they were
not completely eliminated and continued with a similar frequency, thus demonstrating
the role of peripheral reflex mechanism in the modulation of tremor, but not as a
generator. EMS should be further explored as a possible therapeutic intervention for
tremor in PD.
Keywords
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Article info
Publication history
Published online: August 25, 2015
Accepted:
August 23,
2015
Received in revised form:
August 21,
2015
Received:
March 21,
2015
Identification
Copyright
© 2015 Elsevier B.V. Published by Elsevier Inc. All rights reserved.
