Surgical therapy for multiple sclerosis tremor: a 12-year follow-up study

Area of Science:

• Neurology
• Neurosurgery
• Medical Technology

Background:

• Severe tremor in multiple sclerosis (MS) significantly impacts patient disability.
• Medications are often ineffective for managing MS-related tremor.
• Neurosurgical interventions like deep brain stimulation (DBS) and thalamotomy offer potential tremor suppression, but long-term efficacy is not well-established.

Purpose of the Study:

• To evaluate the long-term outcomes of surgical interventions for severe MS tremor.
• To assess tremor control, disability progression, and survival rates 12 years post-surgery.

Main Methods:

• A prospective 12-year follow-up study of nine patients with MS tremor who underwent either thalamotomy or DBS.
• Disability measures were recorded at baseline and 12 months post-surgery.
• Long-term data collection included tremor status, disability progression (Expanded Disability Status Scale), and mortality.

Main Results:

• Initial surgical success was observed in all patients, but tremor recurred in the median of 3 months.
• Median tremor-free survival was 4.3%, with two DBS patients achieving 5-year tremor suppression.
• At 12 years, survivors remained severely disabled (EDSS 8-8.5), and five patients had died, with a median post-operative survival of 5.8 years.

Conclusions:

• Surgical interventions for severe MS tremor offer limited long-term benefit, with a median duration of relief of only 3 months.
• The study highlights a poor long-term prognosis, characterized by progressive disability and increased mortality.
• Findings underscore the need for cautious consideration of long-term outcomes in future surgical trials for MS tremor.