Deep brain stimulation for essential tremor in a Philippine public tertiary hospital: a case report on the first institutional experience and narrative review of evidence from lower-middle-income countries

Essential tremor can cause substantial functional disability. Deep brain stimulation of the ventral intermediate nucleus is an established treatment for medically refractory essential tremor, but the extent of published clinical evidence from lower-middle-income countries remains unclear. We describe the first institutional experience in a Philippine public tertiary hospital and present a narrative review of relevant clinical evidence and service delivery challenges. A 64-year-old Filipino woman with a 20-year history of progressive bilateral upper-limb, head, and voice tremor underwent bilateral ventral intermediate nucleus deep brain stimulation after inadequate response to propranolol, topiramate, and laryngeal botulinum toxin injection. Her total Fahn–Tolosa–Marin Tremor Rating Scale score decreased from 52/144 before surgery to 17/144 postoperatively, representing a 67.3% reduction. Head tremor resolved, while upper-limb and voice tremor improved. Clinical benefit persisted through 3 months after two programming sessions, without reported procedure- or stimulation-related adverse effects. The accompanying narrative review drew on searches of Scopus, CINAHL, and MEDLINE (PubMed) through January 2026, supplemented by reference list and citation checking. Lower-middle-income settings were identified using the World Bank Fiscal Year 2026 classification. Contextual reports highlighted challenges involving referral pathways, specialist training, procedural experience, treatment costs, payer coverage, and geographic access. Reports of general deep brain stimulation utilization and mixed-indication cohorts did not provide separately extractable essential tremor-specific outcomes. This case illustrates the feasibility of bilateral ventral intermediate nucleus deep brain stimulation for essential tremor in a Philippine public tertiary hospital, with meaningful short-term improvement. The narrative review highlights gaps in essential tremor-specific evidence from lower-middle-income settings and practical challenges to service delivery. A single case with 3 months of follow-up cannot establish long-term effectiveness or program sustainability. Longer follow-up, standardized outcome reporting, and financial and workforce support are needed to inform service development.