August 1, 2026

@michaelokun

One topic that generated lively discussion at the Aspen Movement Disorders Course was whether the next generation of wearable, AI-driven closed-loop devices might finally begin to fulfill the promise of treating tremor. Many experts remain appropriately skeptical because earlier wearable technologies often failed to deliver meaningful, sustained clinical benefit. However, the randomized JAMA Neurology trial by Ondo and colleagues offers an intriguing glimpse of what may be different this time. Their transcutaneous peripheral nerve stimulation (TPNS) system continuously adapts stimulation to the person's own tremor physiology, and the study demonstrated meaningful improvements in activities of daily living that became more pronounced over 90 days compared with sham treatment. While this is not a cure and longer-term studies are still needed, it represents an important shift from "always on" stimulation toward intelligent, personalized, closed-loop therapy. Time will ultimately judge whether this and other AI-enabled wearable systems become part of routine tremor care, but the field finally appears to be moving beyond simple gadgets toward data-driven neuromodulation that learns, adapts, and may improve quality of life.