Stereotactic radiosurgery for medically refractory multiple sclerosis-related tremor

Area of Science:

• Neurosurgery
• Neurology
• Radiotherapy

Background:

• Multiple sclerosis (MS) can cause severe intention tremor, potentially exacerbated by conventional radiotherapy.
• Radiosurgery, specifically Gamma Knife thalamotomy (GKT), offers a targeted approach to limit radiation exposure.
• GKT is an established treatment for essential and Parkinson's disease-related tremors.

Purpose of the Study:

• To evaluate the efficacy and safety of Gamma Knife thalamotomy (GKT) for medically refractory MS-related tremor.

Main Methods:

• Retrospective analysis of 15 MS patients undergoing GKT targeting the nucleus ventralis intermedius (VIM).
• Radiosurgery delivered at a median dose of 140 Gy.
• Tremor and functional outcomes assessed using the Fahn-Tolosa-Marin clinical tremor rating scale.

Main Results:

• Significant tremor improvement observed in 13 patients contralateral to surgery.
• Tremor arrest achieved in 4 patients within a median of 4.5 months.
• Most patients experienced excellent or good tremor and functional improvements; adverse events were temporary or manageable.

Conclusions:

• Gamma Knife thalamotomy is a minimally invasive and effective procedure for managing medically refractory MS tremor.
• GKT provides substantial tremor reduction and functional gains in multiple sclerosis patients.