Peripheral Nerve Stimulation for Essential Tremor: a Systematic Review and Meta-Analysis of Effectiveness and Safety

Essential tremor (ET) is the most prevalent movement disorder worldwide. There are limited current pharmacological therapies, and their side effects often preclude adequate doses. Surgical therapies, such as Deep Brain Stimulation (DBS) and Focused Ultrasound (FUS), are reserved for patients with tremor that debilitates activities of daily living (ADLs). Peripheral nerve stimulation (PNS), including transcutaneous afferent patterned stimulation (TAPS) and transcutaneous peripheral nerve stimulation (TPNS), has emerged as a promising non-invasive neuromodulatory approach for many patients with intermediate symptoms.

A systematic review and meta-analysis following PRISMA 2020 guidelines was conducted, with searches across PubMed, Scopus, Cochrane, and Web of Science. Studies enrolling patients with ET assessing TAPS and TPNS were included. Primary outcomes were tremor severity (TETRAS performance scale, total TETRAS) and tremor amplitude. Secondary outcomes included functional disability (BF-ADL, TETRAS-mADL) and safety.