{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T04:19:13Z","timestamp":1788841153994,"version":"build-2803163510"},"reference-count":97,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,8,3]],"date-time":"2021-08-03T00:00:00Z","timestamp":1627948800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:p>Deep brain stimulation (DBS) of the thalamus is an effective treatment for medically refractory essential, dystonic and Parkinson's tremor. It may also provide benefit in less common tremor syndromes including, post-traumatic, cerebellar, Holmes, neuropathic and orthostatic tremor. The long-term benefit of DBS in essential and dystonic tremor (ET\/DT) often wanes over time, a phenomena referred to as stimulation \u201ctolerance\u201d or \u201chabituation\u201d. While habituation is generally accepted to exist, it remains controversial. Attempts to quantify habituation have revealed conflicting reports. Placebo effects, loss of micro-lesional effect, disease related progression, suboptimal stimulation and stimulation related side-effects may all contribute to the loss of sustained long-term therapeutic effect. Habituation often presents as substantial loss of initial DBS benefit occurring as early as a few months after initial stimulation; a complex and feared issue when faced in the setting of optimal electrode placement. Simply increasing stimulation current tends only to propagate tremor severity and induce stimulation related side effects. The report by Paschen and colleagues of worsening tremor scores in the \u201cOn\u201d vs. \u201cOff\u201d stimulation state over time, even after accounting for \u201crebound\u201d tremor, supports the concept of habituation. However, these findings have not been consistent across all studies. Chronic high intensity stimulation has been hypothesized to induce detrimental plastic effects on tremor networks, with some lines of evidence that DT and ET may be more susceptible than Parkinson's tremor to habituation. However, Tsuboi and colleague's recent longitudinal follow-up in dystonic and \u201cpure\u201d essential tremor suggests otherwise. Alternatively, post-mortem findings support a biological adaption to stimulation. The prevalence and etiology of habituation is still not fully understood and management remains difficult. A recent study reported that alternating thalamic stimulation parameters at weekly intervals provided improved stability of tremor control consistent with reduced habituation. In this article the available evidence for habituation after DBS for tremor syndromes is reviewed; including its prevalence, time-course, possible mechanisms; along with expected long-term outcomes for tremor and factors that may assist in predicting, preventing and managing habituation.<\/jats:p>","DOI":"10.3389\/fneur.2021.696950","type":"journal-article","created":{"date-parts":[[2021,8,3]],"date-time":"2021-08-03T00:35:35Z","timestamp":1627950935000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":41,"title":["Habituation After Deep Brain Stimulation in Tremor Syndromes: Prevalence, Risk Factors and Long-Term Outcomes"],"prefix":"10.3389","volume":"12","author":[{"given":"James","family":"Peters","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Tisch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,8,3]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1002\/mds.27121","article-title":"Consensus Statement on the classification of tremors. from the task force on tremor of the International Parkinson and Movement Disorder Society","volume":"33","author":"Bhatia","year":"2018","journal-title":"Mov Disord."},{"key":"B2","doi-asserted-by":"publisher","first-page":"815","DOI":"10.1016\/S1474-4422(05)70226-X","article-title":"Prevalence of movement disorders in men and women aged 50-89 years (Bruneck Study cohort): a population-based study","volume":"4","author":"Wenning","year":"2005","journal-title":"Lancet Neurol."},{"key":"B3","doi-asserted-by":"publisher","first-page":"317","DOI":"10.1007\/BF01562492","article-title":"Ligation of anterior choroidal artery for involuntary movements parkinsonism","volume":"27","author":"Cooper","year":"1953","journal-title":"Psychiatric Q."},{"key":"B4","doi-asserted-by":"publisher","first-page":"337","DOI":"10.1093\/brain\/83.2.337","article-title":"Physiological observations in stereotaxic operations in extrapyramidal motor disturbances","volume":"83","author":"Hassler","year":"1960","journal-title":"Brain."},{"key":"B5","first-page":"515","article-title":"Stereotactic surgery for tremor. 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