Thalamic deep brain stimulation for tremor among multiple sclerosis patients
- Klinika Nowotworów Układu Nerwowego, Centrum Onkologii – Instytut w Warszawie
- Oddział Kliniczny Kliniki Neurologii, Szpital Uniwersytecki w Krakowie
- Medtronic Poland
- II Klinika Neurologii, Instytut Psychiatrii i Neurologii w Warszawie
- Gumed Klinika Neurochirurgii, Smoluchowskiego
open access
Abstract
Disabling tremor might be the main cause of disability of multiple sclerosis (MS) patients. Neuromodulation with deep brain stimulation of the thalamic nucleus ventralis intermedius (Vim DBS) is a well accepted method of neurosurgical treatment of tremor related to essential tremor or Parkinson disease. Vim DBS is not widely used to control MS tremor.
Material and methodsFive MS patients with tremor (3 females and 2 males) were treated with Vim DBS. Age at implantation was 37 ± 5 years. MS lasted from 5 to 12 years (mean 6) and tremor was the main cause of disability of those patients from 2 to 5 years (mean 3) before surgery. Clinical condition of the group was evaluated with spirography, the modified Fahn scale and the modified Activity of Daily Living (ADL) scale. Evaluations were performed before surgery and 3 months after surgery. MRI exclusion criteria were the presence of a thalamic hyperintense signal in T2-weighted images or ventricular enlargement. The procedures of implantation were performed under local and general anaesthesia.
ResultsIntensity of contralateral limb tremor during intraoperative macrostimulation was reduced in the whole group. The therapeutic effect of DBS was maintained at three-month follow-up. Mean contralateral limb tremor reduction was 40%. Mean ADL score improved by 18%. No mortality or morbidity was reported in the group.
ConclusionsThe study confirms the value and safety of Vim DBS for treatment of MS-related tremor. Further study on a larger population and introduction of a qualification protocol might increase efficacy of the treatment.
Abstract
Disabling tremor might be the main cause of disability of multiple sclerosis (MS) patients. Neuromodulation with deep brain stimulation of the thalamic nucleus ventralis intermedius (Vim DBS) is a well accepted method of neurosurgical treatment of tremor related to essential tremor or Parkinson disease. Vim DBS is not widely used to control MS tremor.
Material and methodsFive MS patients with tremor (3 females and 2 males) were treated with Vim DBS. Age at implantation was 37 ± 5 years. MS lasted from 5 to 12 years (mean 6) and tremor was the main cause of disability of those patients from 2 to 5 years (mean 3) before surgery. Clinical condition of the group was evaluated with spirography, the modified Fahn scale and the modified Activity of Daily Living (ADL) scale. Evaluations were performed before surgery and 3 months after surgery. MRI exclusion criteria were the presence of a thalamic hyperintense signal in T2-weighted images or ventricular enlargement. The procedures of implantation were performed under local and general anaesthesia.
ResultsIntensity of contralateral limb tremor during intraoperative macrostimulation was reduced in the whole group. The therapeutic effect of DBS was maintained at three-month follow-up. Mean contralateral limb tremor reduction was 40%. Mean ADL score improved by 18%. No mortality or morbidity was reported in the group.
ConclusionsThe study confirms the value and safety of Vim DBS for treatment of MS-related tremor. Further study on a larger population and introduction of a qualification protocol might increase efficacy of the treatment.
Keywords
multiple sclerosis, tremor, deep brain stimulation
Title
Thalamic deep brain stimulation for tremor among multiple sclerosis patients
Journal
Neurologia i Neurochirurgia Polska
Issue
Pages
542-545
Page views
677
Article views/downloads
745
DOI
10.1016/S0028-3843(14)60150-X
Bibliographic record
Neurol Neurochir Pol 2010;44(6):542-545.
Keywords
multiple sclerosis
tremor
deep brain stimulation
Authors
Tomasz Mandat
Henryk Koziara
Marcin Tutaj
Rafał Rola
Wiesław Bonicki
Paweł Nauman