Improvement of severe postural cerebellar tremor in multiple sclerosis by chronic thalamic stimulation

Abstract

Tremor can be particularly disabling in patients with multiple sclerosis (MS) and is mildly improved by drug treatment. The efficiency of stereotactic thalamotomy has been reported in a small number of patients but was counterbalanced by severe postoperative complications. Stimulation of the thalamic ventral intermediate nucleus, which is a less aggressive surgical method, is efficient in essential and in parkinsonian tremors. We report here the results of thalamic stimulation in 13 patients with MS with tremor. All patients were subjected to clinical examination, videorecording, and quantification of the functional disability before surgery and 3 months postoperatively. The surgical intervention was well tolerated in all cases. A clear improvement of the tremor was observed in 69.2% of the patients. Functional improvement was more varied and depended on the severity of tremor and coexistence of other neurological symptoms. Of the eight most severely affected patients, seven recovered the possibility to easily catch an object and use it. The results indicate that thalamic stimulation may be useful in the treatment of severe postural cerebellar tremor in MS.

Deep Brain Stimulation and Tremor

“…5 Several studies have examined the effects of thalamic DBS on MS tremor (Table 2). [33][34][35][36][37][38] The majority of these were single-center studies with small sample sizes. One study reported unilateral DBS of the Vim in 13 MS patients (11 relapsing progressive; 2 relapsing remitting) after a follow-up of up to 26 months.…”

“…One study reported unilateral DBS of the Vim in 13 MS patients (11 relapsing progressive; 2 relapsing remitting) after a follow-up of up to 26 months. 33 All patients were diagnosed with severe cerebellar tremor due to MS. There was a decrease in tremor amplitude in all patients and long-term reduction of tremor in 69%.…”

“…There were no serious complications; three patients relapsed within 12 months of the surgery, but in each case this was typical of their MS prior to surgery. 33 In a study of 15 MS patients (10 relapsing remitting; 5 chronic progressive), of whom 14 received unilateral 34 (1999) 14 Ͻ3 to Ͼ12 100% had some sustained benefit in all types of tremor. Berk et al 37 (2002) 12 12 At 2 months: improvements in resting (58%), postural (57%), kinetic (70%) and overall tremor (63%).…”

Evaluation of surgery for Parkinson’s disease

“…14, Of the 38 articles identified for DBS of the thalamus, 16 articles met criteria. [40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55] The review of DBS of the globus pallidus consisted of all 10 articles identified, [56][57][58][59][60][61][62][63][64][65] and DBS of the subthalamic nucleus was based on all 6 articles identified. 62,[66][67][68][69][70] There were 52 articles for adrenal medullary transplantation, but the review includes only the 9 that met criteria.…”

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

“…Geny and colleagues observed that the effective VIM site in multiple sclerosis is often dorsal and lateral to the VIM site that is effective in Parkinson's disease, and that the exact location of the stimulator within the VIM must be selected with attention to the somatotopic distribution within the nucleus. 11 Nguyen and Degos found that stimulation of the upper VIM region was most effective in controlling proximal tremor, while stimulation of the lower part of the VIM was most effective in controlling distal tremor. 8 In most cases, stimulator implantation was unilateral, but bilateral implantations (either staged or simultaneous) and implantations contralateral to a previous thalamotomy were also reported.…”