Research Article| Volume 358, ISSUE 1-2, P146-152, November 15, 2015

Exploring the effect of electrical muscle stimulation as a novel treatment of intractable tremor in Parkinson's disease

  • Onanong Jitkritsadakul
    Chulalongkorn Center of Excellence for Parkinson Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand
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  • Chusak Thanawattano
    Biomedical Signal Processing Laboratory, National Electronics and Computer Technology Center (NECTEC), and National Science and Technology Development Agency (NSTDA), Pathumthani, Thailand
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  • Chanawat Anan
    Chulalongkorn Center of Excellence for Parkinson Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand
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  • Roongroj Bhidayasiri
    Corresponding author at: Chulalongkorn Center of Excellence on Parkinson Disease & Related Disorders, Chulalongkorn University Hospital, 1873 Rama 4 Road, Bangkok 10330, Thailand.
    Chulalongkorn Center of Excellence for Parkinson Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand

    Department of Rehabilitation Medicine, Juntendo University, Tokyo, Japan
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Published:August 25, 2015DOI:


      • 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.



      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.


      To determine the efficacy of EMS as a treatment for drug resistant tremor in PD patients.


      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.


      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.


      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.


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