Responsive Versus Continuous Deep Brain Stimulation for Speech in Essential Tremor: A Pilot Study

Abstract Background Responsive deep brain stimulation (rDBS) uses physiological signals to deliver stimulation when needed. rDBS is hypothesized to reduce stimulation‐induced speech effects associated with continuous DBS (cDBS) in patients with essential tremor (ET). Objective To determine if rDBS reduces cDBS speech‐related side effects while maintaining tremor suppression. Methods Eight ET participants with thalamic DBS underwent unilateral rDBS. Both speech evaluations and tremor severity were assessed across three conditions (DBS OFF, cDBS ON, and rDBS ON). Speech was analyzed using intelligibility ratings. Tremor severity was scored using the Fahn‐Tolosa‐Marin Tremor Rating Scale (TRS). Results During unilateral cDBS, participants experienced reduced speech intelligibility ( P = 0.025) compared to DBS OFF. rDBS was not associated with a deterioration of intelligibility. Both rDBS ( P = 0.026) and cDBS ( P = 0.038) improved the contralateral TRS score compared to DBS OFF. Conclusions rDBS maintained speech intelligibility without loss of tremor suppression. A larger prospective chronic study of rDBS in ET is justified. © 2024 International Parkinson and Movement Disorder Society.