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Thalamic stimulation in patients with multiple sclerosis: long-term follow-up
Michael Schulder1, Thomas J Sernas, Reza Karimi
1Department of Neurosurgery, New Jersey Medical School, Newark, NJ, USA. Schulder@umdnj.edu
Stereotactic and Functional Neurosurgery
|January 28, 2004
Summary
Deep brain stimulation (DBS) can reduce tremor in multiple sclerosis (MS) patients. However, functional improvement is limited by disease progression, making DBS suitable only for carefully selected MS patients.
Area of Science:
- Neurology
- Neurosurgery
Background:
- Multiple sclerosis (MS) is a chronic neurological disease.
- MS often causes disabling tremor.
- Deep brain stimulation (DBS) is a potential treatment for tremor.
Purpose of the Study:
- To assess the long-term efficacy of thalamic DBS for tremor in MS patients.
- To evaluate the impact of DBS on functional status and disease progression.
Main Methods:
- Nine MS patients with tremor underwent thalamic DBS implantation.
- Pre- and postoperative assessments included MRI, EDSS, tremor scales, and neuropsychological testing.
- Follow-up ranged from 9 to 48 months.
Main Results:
- DBS significantly reduced tremor scores in most patients.
- No new MS plaques were observed on MRI related to the electrodes.
- Functional status (EDSS) and cognitive function showed declines consistent with MS progression.
- Three patients maintained worthwhile benefit, one experienced fatigue, and four had severe disease progression.
Conclusions:
- Thalamic DBS effectively decreases tremor in MS patients.
- Functional improvement does not correlate with tremor reduction.
- The benefits of DBS may be limited by MS progression.
- DBS should be considered for carefully selected MS patients with disabling tremor and relatively stable disease.