Improvement of upper limb ataxia and intention tremor allowing cessation of thalamic electrostimulation after four years

Abstract

A 34-year-old female patient suffering from multiple sclerosis was treated with thalamic electrostimulation for right dominant brachial ataxia and intention tremor. At the end of the fourth year, the energy of the battery of the impulse generator was depleted. However, the patient was able to use her hands without major impairment with the stimulator OFF; due to a stable reduction of the degree of ataxia and intention tremor. The opposite thalamus received an electrode that was never activated because of a permanent thalamotomy effect. Thus, it can be concluded that restoration of function by means of deep brain stimulation might have been beneficial towards achieving a reorganization and stabilization of subcortico-cortical and cerebellar circuitry, supporting the process of self-repair in this patient with a less aggressive course of multiple sclerosis. However, scientific proof has yet to be found. This exceptional observation emphasizes the need for longterm studies.

Post-deep brain stimulation — gradual non-stimulation dependent decrease in strength with attenuation of multiple sclerosis tremor

“…This improvement was sustained after the stimulator pulse generator failed and was not associated with the development of weakness in the relevant arm, although there had been a marked deterioration in the patient's gait. The authors postulated that chronic thalamic stimulation may have facilitated the process of local CNS self-repair in their case [12]. The data from our patients and those of Schulder et al [16] suggest that, although this may be the case for the patient described by Moringlane et al [12], it is not generally true as the putative self-repair process runs contrary to the experience of worsening upper limb weakness in our patients and those reported by Schulder et al [16].…”

“…There has been one previous case report by Moringlane et al [12] of a patient with MS, in whom upper limb ataxia and intention tremor improved four years after the insertion of a thalamic stimulator. This improvement was sustained after the stimulator pulse generator failed and was not associated with the development of weakness in the relevant arm, although there had been a marked deterioration in the patient's gait.…”

“…The authors postulated that chronic thalamic stimulation may have facilitated the process of local CNS self-repair in their case [12]. The data from our patients and those of Schulder et al [16] suggest that, although this may be the case for the patient described by Moringlane et al [12], it is not generally true as the putative self-repair process runs contrary to the experience of worsening upper limb weakness in our patients and those reported by Schulder et al [16]. Perhaps their patient had subclinical weakness of the upper limb which was not detected; a plausible suggestion given that their patient also had marked gait deterioration.…”

Effect of Deep Brain Stimulation on Different Speech Subsystems in Patients with Multiple Sclerosis

“…Patients were treated with high-frequency electrical impulses to the left and/or right ventrolateral area of the thalamus into the v.i.m. 17,18 All patients were diagnosed as having definite MS following the criteria of Poser et al 19 They exhibited a severe combined upper and lower limb, truncal, and gait ataxia, which could not be sufficiently suppressed pharmacologically. In two male patients, severe head and shoulder tremor was particularly accentuated.…”

“…31 The importance of these parameters in the differentiation of voice production patterns has been documented in a number of recent studies. 12,14,18,25,26,31,32 The phonatory and articulatory behavior of the patients was analyzed at group and at individual level with and without stimulation. The patients' group and individual behavior was also compared with normal speakers' articulation and phonatory behavior (10 male and 10 female speakers).…”