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Daily Medical Update
Benign essential tremor
Wednesday, August 19, 2026
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🔬 Practice-Changing Findings
Evidence from RCTs and meta-analyses published in the
last 12 months.
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Neurosurgical review (2026) - Meta-Analysis
Key Findings
- Across 463 patients in five cohort studies, DBS produced greater improvement in total CRST scores than MRgFUS (MD 5.12; 95% CI 1.08-9.16; P = .01).
- Response rates and CRST Part A scores did not differ significantly between treatments; paresthesia, gait instability, and dysphagia increased with MRgFUS, while rare infection and hemorrhage were reported more often with DBS without significant between-group differences.
📋 Practice Implication: Use the choice between DBS and MRgFUS as an individualized trade-off: DBS may provide greater overall rating-scale improvement, whereas MRgFUS avoids implanted hardware but carries more sensory and gait-related adverse effects in this comparison.
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Parkinsonism & related disorders (2026) - Randomized Controlled Trial
Key Findings
- Suvecaltamide did not significantly improve the primary TETRAS composite score versus placebo at week 12; the 30-mg mean difference was -0.91 points (95% CI -2.88 to 1.06; P = .3626).
- At 30 mg, at least 1-point CGI-S improvement occurred in 62.8% versus 50.0% with placebo (nominal P = .0771); dizziness and paresthesia were reported in 11.4% and 8.6%, respectively.
📋 Practice Implication: Suvecaltamide should remain investigational rather than replacing established therapy, because this phase 2b study showed dose-related numerical signals but no statistically significant primary or key secondary efficacy benefit.
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JAMA neurology (2025) - Randomized Controlled Trial
Key Findings
- At 90 days, modified TETRAS activities-of-daily-living scores fell by 6.9 points with active TPNS versus 2.7 points with sham stimulation (P < .001).
- Skin irritation increased to 33.7% of TPNS participants versus 4.8% of sham participants; other device-related symptoms were reported in isolated participants.
📋 Practice Implication: For patients seeking a home-based, noninvasive option, TPNS offers clinically relevant functional improvement, but counseling should include the substantially higher frequency of local skin irritation.
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Neurosurgical review (2026) - Meta-Analysis
Key Findings
- Across 12 studies involving 914 participants, active PNS reduced TETRAS performance tremor intensity versus control (MD -0.92; 95% CI -1.63 to -0.21; P = .01).
- PNS also improved Bain and Findley activities-of-daily-living scores (MD -1.90; 95% CI -2.97 to -0.83; P = .0005), with benefits persisting up to three months and adverse events mainly limited to transient skin irritation.
📋 Practice Implication: PNS is a reasonable short-term bridge between medication and invasive neurosurgery, while the modest follow-up duration means durability and long-term comparative effectiveness still need confirmation.
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European journal of neurology (2026) - Systematic Review
Key Findings
- At 12 months after the second treatment, CRST A+B scores decreased 58% (21.0 to 8.8), CRST C decreased 74.2%, and QUEST scores decreased 68.7%.
- Head tremor and voice tremor decreased by 73.8% and 40.3%, respectively; 95.2% of adverse events were mild and 88% were transient, with cognition globally preserved at one year aside from selective verbal-memory decline.
📋 Practice Implication: Staged bilateral MRgFUS may extend incisionless treatment to selected patients with persistent bilateral or midline tremor, but the observational cohort and selective memory signal support careful patient selection and cognitive follow-up.
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Summary
The evidence supports several nonpharmacologic options for medication-refractory essential tremor, including DBS, focused ultrasound, and peripheral nerve stimulation, while a phase 2b suvecaltamide trial did not meet its prespecified efficacy endpoints. Focused ultrasound showed sustained benefit after staged bilateral treatment, but procedure-specific adverse effects and limited follow-up remain important in treatment selection.
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