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Alterations in Muscle Tone lll

Rigidity and myotonia are distinct abnormalities of muscle tone that affect resistance and relaxation during movement. Although both involve altered muscle contraction, they arise from different neurological and muscular mechanisms.CharacteristicsRigidity is characterized by uniform resistance to passive movement across the entire range, independent of speed, affecting flexors and extensors equally. It may appear as lead-pipe rigidity (smooth, constant resistance) or cogwheel rigidity...

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MRI-guided Focused Ultrasound Thalamotomy for Patients with Medically-refractory Essential Tremor
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Permanent tremor reduction during thalamic stimulation in multiple sclerosis.

Wesley Thevathasan1, Patrick Schweder, Carole Joint

  • 1Nuffield Department of Surgery, University of Oxford, Oxford, UK. wesley.thevathasan@nds.ox.ac.uk

Journal of Neurology, Neurosurgery, and Psychiatry
|October 2, 2010
PubMed
Summary

Thalamic stimulation for multiple sclerosis (MS) tremor can lead to permanent tremor reduction (PTR), even without limb weakness. This suggests thalamic stimulation might cause localized lesions, offering a potential new mechanism for treating MS tremor.

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Area of Science:

  • Neurology
  • Neurosurgery
  • Neuroscience

Background:

  • Thalamic stimulation is a reversible treatment for tremor, unlike lesioning.
  • Permanent tremor reduction (PTR) in multiple sclerosis (MS) during thalamic stimulation has been observed.
  • PTR was previously attributed to limb weakness, but this study investigates other mechanisms.

Purpose of the Study:

  • To assess permanent tremor reduction (PTR) in patients with MS tremor undergoing thalamic stimulation.
  • To investigate the relationship between limb strength, stimulation duration, and PTR.
  • To explore potential underlying mechanisms of PTR, including localized thalamic changes.

Main Methods:

  • Assessed tremor severity and limb strength preoperatively, early postoperatively, and late postoperatively (mean 5.2 years).
  • Rated tremor severity on and off stimulation using validated clinical scales.
  • Examined thalamic parenchyma surrounding electrode tracts with MRI after explantation.

Main Results:

  • PTR occurred in 11 of 18 upper limbs with MS tremor.
  • PTR was significant and universal in limbs receiving long-term effective stimulation (>2 years).
  • MRI revealed thalamic lesions adjacent to electrode tracts in limbs with PTR, even with preserved limb strength.

Conclusions:

  • MS tremor can experience permanent improvement with thalamic stimulation, independent of limb weakness.
  • Findings support the hypothesis that thalamic stimulation may induce localized demyelinative lesioning in MS.
  • PTR may represent a novel therapeutic mechanism beyond simple tremor suppression.