Emerging noninvasive approaches for suppression of pathological tremor

• Pathological tremor affects over 40 million people worldwide and significantly impairs daily activities and quality of life.¹
• Pharmacological treatments show limited efficacy, with up to 30% discontinuation rates.¹
• Deep brain stimulation achieves significant tremor reduction but is often unsuitable due to age, comorbidities, or patient preference.¹
• Safe and effective noninvasive alternatives are being developed as innovative, patient-friendly options to DBS.^{1 1}

Weekly enrichment (2026-07-20)

• The source is a clinical application review (Montero-Pardo et al., IEEE Reviews in Biomedical Engineering, 2026; DOI 10.1109/rbme.2025.3639754) that analyzed 134 studies spanning 1969–2025.^{2 3}
• Approaches were grouped into three modalities: force-controlling (wearable orthoses and functional electrical stimulation), central neuromodulation (TMS, tACS/tDCS, low-intensity focused ultrasound, and transcutaneous spinal cord stimulation), and peripheral neuromodulation (afferent stimulation and vibration).^{2 4}
• The review underscores the growing burden: Parkinson’s disease is projected to affect over 12.9 million people globally by 2040, US annual direct PD medical costs are projected to exceed $40.4 billion by 2037, and essential tremor already costs an estimated $9.4 billion annually in the US.²
• Force-controlling strategies achieved the highest average tremor reduction across modalities, but none has reached the market, and clinical translation is limited by poor wearability (bulk, weight, rigidity) and, for FES, muscle fatigue and discomfort.²
• FES studies enrolled only about 5.69 ± 4.29 patients each, included no sham or control group, and were all conducted in laboratory or hospital settings; orthosis studies averaged 10.94 ± 10.12 participants, with just 2 of 16 including a sham group, 1 a control group, and 3 conducted at home.²
• Most force-controlling studies (13 of 16 for both orthoses and FES) assessed only acute, same-day effects rather than lasting tremor reduction.²
• Central neuromodulation produced only moderate effects, whereas peripheral neuromodulation has gained the most clinical traction, with several devices already commercially available.^{2 4}
• The main obstacle to comparing techniques is heterogeneity in study design, patient populations, technology maturity, and outcome metrics; the authors call for larger multicenter trials, standardized outcome measures, and accessibility considerations to enable personalized, evidence-based treatment selection.^{2 3}

Footnotes

1. http://ieeexplore.ieee.org/document/11301615 ↩ ↩² ↩³ ↩⁴ ↩⁵

2. https://doi.org/10.1109/rbme.2025.3639754 ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶ ↩⁷ ↩⁸

3. https://digital.csic.es/handle/10261/413311 ↩ ↩²

4. https://vbn.aau.dk/en/publications/emerging-noninvasive-approaches-for-the-suppression-of-pathologic/ ↩ ↩²