Thalamic deep brain stimulation for the treatment of tremor due to multiple sclerosis: a prospective study of tremor and quality of life

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Object. In several studies a significant reduction in tremor after thalamic deep brain stimulation (DBS) has been reported among patients with multiple sclerosis (MS). It has not been determined if this results in an improved quality of life. In this study the authors prospectively evaluated the effects of thalamic DBS on tremor and quality of life.

Methods. Videotapes of the patients' tremor were made preoperatively and 2 and 12 months postoperatively, and tremor was scored by a neurologist blinded to the treatment. Patients were tested pre- and postoperatively to measure any changes in their reported ability to perform selected activities of daily living and in their health-related quality of life. Patients were asked to complete a questionnaire about their satisfaction with the surgery. Postoperative changes were examined using paired t-tests.

There were significant reductions in postural, action, and overall tremor at 2 and 12 months postoperatively. The patients' reported ability to feed themselves was significantly improved 2 months after surgery (p = 0.01). There were short-term trends toward improvement in reported dressing ability, personal hygiene, and writing. There were no significant changes in the SF-36 subscales or total score.

Conclusions. In this cohort of patients with MS who suffered from tremor, thalamic DBS significantly improved their tremor and ability to feed themselves. Patient satisfaction with the procedure, however, was variable. Preoperative patient education about what functions might (and might not) be improved is crucial to avoid unrealistic expectations. Our results indicate that younger patients with MS tremor who had a shorter disease duration and no superimposed ataxia benefited most from this surgery.

Article Information

Address reprint requests to: Christopher Honey, M.D., D.Phil., Surgical Centre for Movement Disorders, University of British Columbia, Suite 325, 700 West 10th Avenue, Vancouver, British Columbia, Canada V5Z 4E5. email: choney@interchange.ubc.ca.

© AANS, except where prohibited by US copyright law.

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Figures

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    Bar graphs showing pre- and postoperative tremor in patients with MS who underwent DBS. Each type of tremor was scored on a 4-point scale, with 4 being most impaired. The total tremor score is the sum of the resting, postural, and action scores. All components of tremor were significantly reduced postoperatively, with precise values given in text. *p < 0.05, **p < 0.001. SEM = standard error of the mean.

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    Bar graph showing changes in ADLs in patients with MS after treatment with DBS. Reported functioning in each domain was scored on a 4-point scale, with 4 being most impaired. There was a significant improvement in reported feeding ability; however, the trend toward improvements in reported dressing, writing, and personal hygiene was not sustained. *p = 0.01.

  • View in gallery

    Bar graph showing responses by patients to satisfaction survey items.

References

  • 1.

    Alusi SHGlickman SAziz TZet al: Tremor in multiple sclerosis. J Neurol Neurosurg Psychiatry 66:1311341999Alusi SH Glickman S Aziz TZ et al: Tremor in multiple sclerosis. J Neurol Neurosurg Psychiatry 66:131–134 1999

  • 2.

    Andersson PBGoodkin DE: Current pharmacologic treatment of multiple sclerosis symptoms. West J Med 165:3133171996Andersson PB Goodkin DE: Current pharmacologic treatment of multiple sclerosis symptoms. West J Med 165:313–317 1996

  • 3.

    Barnett GHKinkel RPBashin Cet al: Stereotactic thalamotomy for intractable tremor in multiple sclerosis (MS). Neurology 42 (Suppl 3):3271992 (Abstract)Barnett GH Kinkel RP Bashin C et al: Stereotactic thalamotomy for intractable tremor in multiple sclerosis (MS). Neurology 42 (Suppl 3):327 1992 (Abstract)

  • 4.

    Benabid ALBenazzouz AHoffmann Det al: Long-term electrical inhibition of deep brain targets in movement disorders. Mov Disord 13 (Suppl 3):1191251998Benabid AL Benazzouz A Hoffmann D et al: Long-term electrical inhibition of deep brain targets in movement disorders. Mov Disord 13 (Suppl 3):119–125 1998

  • 5.

    Brice JMcLellan L: Supression of intention tremor by contingent deep-brain stimulation. Lancet 1:122112221980Brice J McLellan L: Supression of intention tremor by contingent deep-brain stimulation. Lancet 1:1221–1222 1980

  • 6.

    Broager BFog T: Thalamotomy for the relief of intention tremor in multiple sclerosis. Acta Neurol Scand 38 (Suppl 3):1531561962Broager B Fog T: Thalamotomy for the relief of intention tremor in multiple sclerosis. Acta Neurol Scand 38 (Suppl 3):153–156 1962

  • 7.

    Caparros-Lefebvre DRuchoux MMBlond Set al: Long-term thalamic stimulation in Parkinson's disease: postmortem anatomoclinical study. Neurology 44:185618601994Caparros-Lefebvre D Ruchoux MM Blond S et al: Long-term thalamic stimulation in Parkinson's disease: postmortem anatomoclinical study. Neurology 44:1856–1860 1994

  • 8.

    Cohen J: Statistical Power Analysis for the Behavioral Sciences. New York: Academic Press1969Cohen J: Statistical Power Analysis for the Behavioral Sciences. New York: Academic Press 1969

  • 9.

    Cooper IS: Neurosurgical alleviation of intention tremor of multiple sclerosis and cerebellar disease. N Engl J Med 263:4414441960Cooper IS: Neurosurgical alleviation of intention tremor of multiple sclerosis and cerebellar disease. N Engl J Med 263:441–444 1960

  • 10.

    Critchley GRRichardson PL: Vim thalamotomy for the relief of the intention tremor in multiple sclerosis. Br J Neurosurg 12:5595621998Critchley GR Richardson PL: Vim thalamotomy for the relief of the intention tremor in multiple sclerosis. Br J Neurosurg 12:559–562 1998

  • 11.

    Fahn STolosa EMarin C: Clinical rating scale for tremor in Jankovic JTolosa E (eds): Parkinson's Disease and Movement Disordersed 2. Baltimore: Williams & Wilkins1993 pp 271280Fahn S Tolosa E Marin C: Clinical rating scale for tremor in Jankovic J Tolosa E (eds): Parkinson's Disease and Movement Disorders ed 2. Baltimore: Williams & Wilkins 1993 pp 271–280

  • 12.

    Geny CNguyen JPPollin Bet al: Improvement of severe postural cerebellar tremor in multiple sclerosis by chronic thalamic stimulation. Mov Disord 11:4894941996Geny C Nguyen JP Pollin B et al: Improvement of severe postural cerebellar tremor in multiple sclerosis by chronic thalamic stimulation. Mov Disord 11:489–494 1996

  • 13.

    Haddow LJMumford CWhittle IR: Stereotactic treatment of tremor due to multiple sclerosis. Neurosurg Q 7:23341997Haddow LJ Mumford C Whittle IR: Stereotactic treatment of tremor due to multiple sclerosis. Neurosurg Q 7:23–34 1997

  • 14.

    Hooper JTaylor RPentland Bet al: Rater reliability in Fahn's tremor rating scale in patients with multiple sclerosis. Arch Phys Med Rehabil 79:107610791998Hooper J Taylor R Pentland B et al: Rater reliability in Fahn's tremor rating scale in patients with multiple sclerosis. Arch Phys Med Rehabil 79:1076–1079 1998

  • 15.

    Hooper JWhittle IR: Long-term outcome after thalamotomy for movement disorders in multiple sclerosis. Lancet 352:19841998 (Letter)Hooper J Whittle IR: Long-term outcome after thalamotomy for movement disorders in multiple sclerosis. Lancet 352:1984 1998 (Letter)

  • 16.

    Montgomery EB JrBaker KBKinkel RPet al: Chronic thalamic stimulation for the tremor of multiple sclerosis. Neurology 53:6256281999Montgomery EB Jr Baker KB Kinkel RP et al: Chronic thalamic stimulation for the tremor of multiple sclerosis. Neurology 53:625–628 1999

  • 17.

    Nguyen JPFeve AKeravel Y: Is electrostimulation preferable to surgery for upper limb ataxia? Curr Opin Neurol 9:4454501996Nguyen JP Feve A Keravel Y: Is electrostimulation preferable to surgery for upper limb ataxia? Curr Opin Neurol 9:445–450 1996

  • 18.

    Poser CMPaty DWScheinberg L: New diagnostic criteria for multiple sclerosis: guidelines for research protocols in Poser CMPaty DWScheinberg Let al (eds): The Diagnosis of Multiple Sclerosis. New York: Thieme-Stratton1984 pp 225229Poser CM Paty DW Scheinberg L: New diagnostic criteria for multiple sclerosis: guidelines for research protocols in Poser CM Paty DW Scheinberg L et al (eds): The Diagnosis of Multiple Sclerosis. New York: Thieme-Stratton 1984 pp 225–229

  • 19.

    Schuurman PRBosch DABossuyt PMMet al: A comparison of continuous thalamic stimulation and thalamotomy for suppression of severe tremor. N Engl J Med 342:4614682000Schuurman PR Bosch DA Bossuyt PMM et al: A comparison of continuous thalamic stimulation and thalamotomy for suppression of severe tremor. N Engl J Med 342:461–468 2000

  • 20.

    Shahzadi STasker RRLozano A: Thalamotomy for essential and cerebellar tremor. Stereotact Funct Neurosurg 65:11171995Shahzadi S Tasker RR Lozano A: Thalamotomy for essential and cerebellar tremor. Stereotact Funct Neurosurg 65:11–17 1995

  • 21.

    Siegfried J: Therapeutic stereotactic procedures on the thalamus for motor movement disorders. Acta Neurochir 124:14181993Siegfried J: Therapeutic stereotactic procedures on the thalamus for motor movement disorders. Acta Neurochir 124:14–18 1993

  • 22.

    Siegfried JLippitz B: Chronic electrical stimulation of the VLVPL complex and of the pallidum in the treatment of movement disorders: personal experience since 1982. Stereotact Funct Neurosurg 62:71751994Siegfried J Lippitz B: Chronic electrical stimulation of the VLVPL complex and of the pallidum in the treatment of movement disorders: personal experience since 1982. Stereotact Funct Neurosurg 62:71–75 1994

  • 23.

    Speelman JDVan Manen J: Stereotactic thalamotomy for the relief of intention tremor of multiple sclerosis. J Neurol Neurosurg Psychiatry 47:5965991984Speelman JD Van Manen J: Stereotactic thalamotomy for the relief of intention tremor of multiple sclerosis. J Neurol Neurosurg Psychiatry 47:596–599 1984

  • 24.

    Stolp-Smith KACarter JLRohe DEet al: Management of impairment, disability and handicap due to multiple sclerosis. Mayo Clin Proc 72:118411961997Stolp-Smith KA Carter JL Rohe DE et al: Management of impairment disability and handicap due to multiple sclerosis. Mayo Clin Proc 72:1184–1196 1997

  • 25.

    Struppler AErbel FVelho F: An overview on the pathophysiology of parkinsonian and other pathological tremors. Prog Clin Neurophysiol 5:1141281978Struppler A Erbel F Velho F: An overview on the pathophysiology of parkinsonian and other pathological tremors. Prog Clin Neurophysiol 5:114–128 1978

  • 26.

    Taha JMJanszen MAFavre J: Thalamic deep brain stimulation for the treatment of head, voice, and bilateral limb tremor. J Neurosurg 91:68721999Taha JM Janszen MA Favre J: Thalamic deep brain stimulation for the treatment of head voice and bilateral limb tremor. J Neurosurg 91:68–72 1999

  • 27.

    Tasker RRMunz MJunn FSCKet al: Deep brain stimulation and thalamotomy for tremor compared. Acta Neurochir Suppl 68:49531997Tasker RR Munz M Junn FSCK et al: Deep brain stimulation and thalamotomy for tremor compared. Acta Neurochir Suppl 68:49–53 1997

  • 28.

    Tranchant CBhatia KPMarsden CD: Movement disorders in multiple sclerosis. Mov Disord 10:4184231995Tranchant C Bhatia KP Marsden CD: Movement disorders in multiple sclerosis. Mov Disord 10:418–423 1995

  • 29.

    Ware JE JrSnow KKKosinski Met al: SF-36 Health Survey Manual and Interpretation Guide. Boston: The Health Institute, New England Medical Center1997Ware JE Jr Snow KK Kosinski M et al: SF-36 Health Survey Manual and Interpretation Guide. Boston: The Health Institute New England Medical Center 1997

  • 30.

    Weinshenker BGIssa MBaskerville J: Long-term and short-term outcome of multiple sclerosis: a 3-year follow-up study. Arch Neurol 53:3533581996Weinshenker BG Issa M Baskerville J: Long-term and short-term outcome of multiple sclerosis: a 3-year follow-up study. Arch Neurol 53:353–358 1996

  • 31.

    Whittle IRHaddow LJ: CT guided thalamotomy for movement disorders in multiple sclerosis: problems and paradoxes. Acta Neurochir Suppl 64:13161995Whittle IR Haddow LJ: CT guided thalamotomy for movement disorders in multiple sclerosis: problems and paradoxes. Acta Neurochir Suppl 64:13–16 1995

  • 32.

    Whittle IRHooper JPentland B: Thalamic deep-brain stimulation for movement disorders due to multiple sclerosis. Lancet 351:1091101998 (Letter)Whittle IR Hooper J Pentland B: Thalamic deep-brain stimulation for movement disorders due to multiple sclerosis. Lancet 351:109–110 1998 (Letter)

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