Chronic deep brain stimulation for the treatment of tremor in multiple sclerosis: review and case reports

Wishart H A; Roberts D W; Roth R M; McDonald B C; Coffey D J; Mamourian A C; Hartley C; Flashman L A; Fadul C E; Saykin A J
October 2003
Journal of Neurology, Neurosurgery & Psychiatry;Oct2003, Vol. 74 Issue 10, p1392
Academic Journal
BACKGROUND: Deep brain stimulation (DBS) offers a non-ablative alternative to thalamotomy for the surgical treatment of medically refractory tremor in multiple sclerosis. However, relatively few outcomes have been reported. OBJECTIVE: To provide a systematic review of the published cases of DBS use in multiple sclerosis and to present four additional patients. METHODS: Quantitative and qualitative review of the published reports and description of a case series from one centre. RESULTS: In the majority of reported cases (n=75), the surgical target for DBS implantation was the ventrointeromedial nucleus of the thalamus. Tremor reduction and improvement in daily functioning were achieved in most patients, with 87.7% experiencing at least some sustained improvement in tremor control postsurgery. Effects on daily functioning were less consistently assessed across studies; in papers reporting relevant data, 76.0% of patients experienced improvement in daily functioning. Adverse effects were similar to those reported for DBS in other patient populations. CONCLUSIONS: Few of the studies reviewed used highly standardised quantitative outcome measures, and follow up periods were generally one year or less. Nonetheless, the data suggest that chronic DBS often produces improved tremor control in multiple sclerosis. Complete cessation of tremor is not necessarily achieved, there are cases in which tremor control decreases over time, and frequent reprogramming appears to be necessary.


Related Articles

  • Post-deep brain stimulation – gradual non-stimulation dependent decrease in strength with attenuation of multiple sclerosis tremor. Hyam, J.; Aziz, T.; Bain, P. // Journal of Neurology;Jul2007, Vol. 254 Issue 7, p854 

    Tremor in multiple sclerosis is considered to be a persistent and progressive sign. We describe five patients with multiple sclerosis in whom upper limb tremor severity gradually decreased over a period of several years after deep brain stimulation. In every case this attenuation of tremor was...

  • Stereotactic radiosurgery for movement disorders. Frighetto, Leonardo; Bizzi, Jorge; D'Agostini Annes, Rafael; dos Santos Silva, Rodrigo; Oppitz, Paulo // Surgical Neurology International;2012, Vol. 3 Issue 2, pS10 

    Initially designed for the treatment of functional brain targets, stereotactic radiosurgery (SRS) has achieved an important role in the management of a wide range of neurosurgical pathologies. The interest in the application of the technique for the treatment of pain, and psychiatric and...

  • Deep Brain Stimulation and Tremor Lyons, Kelly E.; Pahwa, Rajesh // Neurotherapeutics;Apr2008, Vol. 5 Issue 2, p331 

    Summary: Deep brain stimulation (DBS) has been used to treat various tremor disorders for several decades. Medication-resistant, disabling essential tremor (ET) is the most common tremor disorder treated with DBS. The treatment has been consistently reported to result in significant benefit in...

  • Reducing Hardware-Related Complications of Deep Brain Stimulation. Constantoyannis, Constantine; Berk, Caglar; Honey, Christopher R.; Mendez, Ivar; Brownstone, Robert M. // Canadian Journal of Neurological Sciences;May2005, Vol. 32 Issue 2, p194 

    Investigates the hardware-related complications of deep brain stimulation (DBS). Use of DBS for the treatment of Parkinson's disease, dystonia, tremor, and pain; Consideration of the infection, malfunction, and lead migration or fracture when evaluating the risk/benefit ratio of the therapy;...

  • Which Approach is Better: Bilateral Versus Unilateral Thalamic Deep Brain Stimulation in Patients with Fragile X-Associated Tremor Ataxia Syndrome. Mehanna, R.; Itin, I. // Cerebellum;Apr2014, Vol. 13 Issue 2, p222 

    Fragile X-associated tremor ataxia syndrome (FXTAS) is a relatively recently described condition that is frequently misdiagnosed as essential tremor and then occasionally treated as such with deep brain stimulation (DBS) to the nucleus ventralis intermedius of the thalamus (Vim). Reports of...

  • Movement Disorders.  // Current Medical Literature: Neurology;2012, Vol. 28 Issue 2, p55 

    The article reviews several studies on movement disorders published in various journals including one on worsening essential tremor following deep brain stimulation, another on long term follow-up of deep brain stimulation of the caudal zona incerta for essential tremor and another on the tremor...

  • Thalamic Deep Brain Stimulation for Essential Tremor: Recommendations for Long-Term Outcome Analysis. Putzke, J.D.; Wharen Jr., R.E.; Obwegeser, A.A.; Wszolek, Z.K.; Lucas, J.A.; Turk, M.F.; Uitti, R.J. // Canadian Journal of Neurological Sciences;Aug2004, Vol. 31 Issue 3, p333 

    Examines the efficacy of thalamic deep brain stimulation (DBS) for tremor control among individuals with essential tremor (ET). Association of stimulation with significant improvement at nearly every postoperative interval as compared to pre-operative and stimulation "off" ratings of activities...

  • The safety and efficacy of thalamic deep brain stimulation in essential tremor: 10 years and beyond. Baizabal-Carvallo, José Fidel; Kagnoff, Melissa N.; Jimenez-Shahed, Joohi; Fekete, Robert; Jankovic, Joseph // Journal of Neurology, Neurosurgery & Psychiatry;May2014, Vol. 85 Issue 5, p567 

    Background Deep brain stimulation (DBS) has proven to be a safe and effective therapy for refractory essential tremor, but information regarding long-term outcomes is lacking. Objectives We aimed to assess the long-term safety and efficacy of DBS in patients with essential tremor. Methods...

  • Your Brain, Explained. Kleinwaks, Rebecca // Men's Health;Nov99, Vol. 14 Issue 9, p134 

    Discusses about the brain's localization of function. Regulation of sex hormones in the hypothalamus's Golgi apparatus; Function of the frontal region; Regulation of aggression in the basolateral nucleus.


Read the Article


Sign out of this library

Other Topics