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

Jonathan A Hyam1, Tipu Z Aziz, Peter G Bain

  • 1Department of Neurosurgery, West London Neurosciences Centre Charing Cross Hospital, London, UK.

Journal of Neurology
|April 14, 2007
PubMed
Summary
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Deep brain stimulation (DBS) for multiple sclerosis (MS) tremor may reduce tremor but can increase limb weakness. In some cases, tremor reduction persisted after DBS was stopped.

Area of Science:

  • Neurology
  • Neurosurgery

Background:

  • Tremor is a common and progressive symptom in multiple sclerosis (MS).
  • Deep brain stimulation (DBS) is a potential intervention for managing severe MS tremor.

Purpose of the Study:

  • To investigate the long-term effects of DBS on upper limb tremor in MS patients.
  • To explore the relationship between tremor changes and motor function following DBS.

Main Methods:

  • Case series describing five patients with MS undergoing DBS for upper limb tremor.
  • Longitudinal assessment of tremor severity and upper limb pyramidal strength over several years.
  • Statistical comparison of tremor changes in limbs with increasing weakness versus those retaining strength.

Main Results:

Related Experiment Videos

  • Upper limb tremor severity decreased in MS patients after DBS, accompanied by increased pyramidal weakness.
  • In two patients, tremor reduction persisted after DBS was discontinued.
  • In one patient with preserved strength, tremor worsened despite ongoing stimulation.
  • A significant difference in tremor change was observed between limbs with increasing weakness and those with retained strength (p = 0.0007).
  • A significant correlation (p = 0.0359) existed between decreasing upper limb strength and decreasing tremor severity.

Conclusions:

  • DBS may reduce MS-related upper limb tremor, but this is often associated with increased pyramidal weakness.
  • The beneficial effect on tremor may persist even after DBS cessation in some individuals.
  • The development of pyramidal weakness appears linked to tremor attenuation during DBS treatment for MS.