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

Wishart, Heather A.

doi:10.1136/jnnp.74.10.1392

Cited by 94 publications

(44 citation statements)

References 20 publications

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“…Chronic VIM stimulation will produce better results but stimulation parameters probably have to be optimized repeatedly. In some smaller studies and case series, amelioration of tremor could be achieved in 87.7% and of activities of daily life in 76% of operated patients [165]. Simultaneously the level of disability and SF-36 subscales remained largely unchanged (class III evidence [166, 167]).…”

Section: Ataxia and Tremormentioning

confidence: 99%

Symptomatic Treatment of Multiple Sclerosis

2006

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Besides immunomodulation and immunosuppression, the specific treatment of symptoms is an essential component of the overall management of multiple sclerosis (MS). Symptomatic treatment is aimed at the elimination or reduction of symptoms impairing the functional abilities and quality of life of the affected patients. Moreover, with symptomatic treatment the development of a secondary physical impairment due to an existing one may be avoided. Many therapeutic techniques as well as different drugs are used for the treatment of MS symptoms, but only a few of them have been investigated, especially in MS patients, and are approved by the national health authorities. Despite an overwhelming number of publications, only a few evidence-based studies exist and consensus reports are very rare, too. Therefore, it seemed necessary to develop a consensus statement on symptomatic treatment of MS comprising existing evidence-based literature as well as therapeutic experience of neurologists who have dealt with these problems over a long time. This consensus paper contains proposals for the treatment of the most common MS symptoms: disorders of motor function and coordination, of cranial nerve function, of autonomic, cognitive, and psychological functions as well as MS-related pain syndromes and epileptic seizures.

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Section: Ataxia and Tremormentioning

confidence: 99%

Symptomatic Treatment of Multiple Sclerosis

2006

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“…3,27,29 Over the course of weeks to months, despite continuous thalamic stimulation, tremor is often refractory or recurs. 18,21,62,66 The effectiveness of ventrolateral thalamic DBS in HT remains uncertain due to the limited number of cases, relatively short follow-up, and diverse outcome scales used 1,13,42,50 (Table 1).…”

Section: Prior Surgical Approaches To Htmentioning

confidence: 99%

Pallidal stimulation for Holmes tremor: clinical outcomes and single-unit recordings in 4 cases

Kilbane

Ramirez‐Zamora

Ryapolova-Webb

et al. 2015

JNS

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OBJECT Holmes tremor (HT) is characterized by irregular, low-frequency (< 4.5 Hz) tremor occurring at rest, with posture, and with certain actions, often affecting proximal muscles. Previous reports have tended to highlight the use of thalamic deep brain stimulation (DBS) in cases of medication-refractory HT. In this study, the authors report the clinical outcome and analysis of single-unit recordings in patients with medication-refractory HT treated with globus pallidus internus (GPi) DBS. METHODS The authors retrospectively reviewed the medical charts of 4 patients treated with pallidal DBS for medication-refractory HT at the University of California, San Francisco, and San Francisco Veterans Affairs Medical Center. Clinical outcomes were measured at baseline and after surgery using an abbreviated motor-severity Fahn-Tolosa-Marin (FTM) tremor rating scale. Intraoperative microelectrode recordings were performed with patients in the awake state. The neurophysiological characteristics identified in HT were then also compared with characteristics previously described in Parkinson's disease (PD) studied at the authors' institution. RESULTS The mean percentage improvement in tremor motor severity was 78.87% (range 59.9%–94.4%) as measured using the FTM tremor rating scale, with an average length of follow-up of 33.75 months (range 18–52 months). Twenty-eight GPi neurons were recorded intraoperatively in the resting state and 13 of these were also recorded during contralateral voluntary arm movement. The mean firing rate at rest in HT was 56.2 ± 28.5 Hz, and 63.5 ± 19.4 Hz with action, much lower than the GPi recordings in PD. GPi unit oscillations of 2–8 Hz were prominent in both patients with HT and those with PD, but in HT, unlike PD, these oscillations were not suppressed by voluntary movement. CONCLUSIONS The efficacy of GPi DBS exceeded that reported in prior studies of ventrolateral thalamus DBS and suggest GPi may be a better target for treating HT. These clinical and neurophysiological findings help illuminate evolving models of HT and highlight the importance of cerebellar–basal ganglia interactions.

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“…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.…”

Section: Multiple Sclerosismentioning

confidence: 99%

Deep Brain Stimulation and Tremor

2008

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Summary: Deep brain stimulation (DBS) has been used to treat various tremor disorders for several decades. Medicationresistant, 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 upper extremity, as well as head and voice tremor, all of which were improved more dramatically with bilateral procedures. These benefits have been demonstrated to be sustained for up to 7 years. DBS has also been shown to be beneficial for the tremor associated with multiple sclerosis and post-traumatic tremor; however, fewer cases have been reported and the benefit is less consistent, less dramatic, and more transient than that seen with ET. The ventral intermediate nucleus of the thalamus is the most common DBS target for tremor disorders, but more recent studies have demonstrated benefits in tremor from DBS of the subthalamic area, primarily the zona incerta. Surgical complications are relatively uncommon and are generally less frequent than those seen with thalamotomy. Stimulation-related effects are usually mild and resolve with adjustment of stimulation parameters. DBS is thus a relatively safe and effective treatment for tremor disorders, particularly for medication-resistant, disabling ET, but may also have some role in medicationresistant, disabling tremor associated with multiple sclerosis and traumatic head injury.

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

Cited by 94 publications

References 20 publications

Symptomatic Treatment of Multiple Sclerosis

Symptomatic Treatment of Multiple Sclerosis

Pallidal stimulation for Holmes tremor: clinical outcomes and single-unit recordings in 4 cases

Deep Brain Stimulation and Tremor

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