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Thalamotomy versus thalamic stimulation for multiple sclerosis tremor

Thalamotomy versus thalamic stimulation for multiple sclerosis tremor
Thalamotomy versus thalamic stimulation for multiple sclerosis tremor
Disabling intractable tremor occurs frequently in patients with multiple sclerosis (MS). There is currently no effective medical treatment available, and the results of surgical intervention have been variable. Thalamotomy has been the mainstay of neurosurgical therapy for intractable MS tremor, however the popularisation of deep brain stimulation (DBS) has led to the adoption of chronic thalamic stimulation in an attempt to ameliorate this condition. With the goal of examining the relative efficacy and adverse effects of these two surgical strategies, we studied twenty carefully selected patients with intractable MS tremor. Thalamotomy was performed in 10 patients, with chronic DBS administered to the remaining 10. Both thalamotomy and thalamic stimulation produced improvements in postural and intention tremor. The mean improvement in postural tremor at 16.2 months following surgery was 78%, compared with a 64% improvement after thalamic stimulation (14.6 month follow-up) (P > 0.05). Intention tremor improved by 72% in the group undergoing thalamotomy, a significantly larger gain than the 36% tremor reduction following DBS (P < 0.05). Early postoperative complications were common in both groups. Permanent complications related to surgery occurred in four patients overall. Following thalamotomy, long-term adverse effects were observed in three patients (30%), and comprised hemiparesis and seizures. Only one patient in the thalamic stimulation group experienced a permanent deficit (monoparesis). We conclude that thalamotomy is a more efficacious surgical treatment for intractable MS tremor, however the higher incidence of persistent neurological deficits in patients receiving lesional surgery may support the use of DBS as the preferred surgical strategy.
deep brain stimulation, thalamotomy, multiple sclerosis, tremor
0967-5868
638-642
Bittar, R.G.
398d329d-2830-44f9-8e06-5e868e226dd4
Hyam, J.
713aae6e-83a5-4d69-9c12-c351f64150e5
Nandi, D.
89b4a04e-5bff-4833-ba6e-52a1a8aba507
Wang, S.
a2223997-9f42-425b-b0c6-1bcb64d9b8fc
Liu, X.
878efcac-76c6-4ca0-8f4a-425f1e9abdac
Joint, C.
423119d0-8e94-47a6-8155-5245f6d4a144
Bain, P.G.
6f63e03e-9273-426e-adc0-72eb1bec9e63
Gregory, R.
fb588148-f426-4235-bbc4-8caeefd82c5a
Stein, J.
060b38b3-f84f-4c31-a1e0-c388eac92628
Aziz, T.Z.
728d8821-5fa0-407f-a09f-5a52038ad170
Bittar, R.G.
398d329d-2830-44f9-8e06-5e868e226dd4
Hyam, J.
713aae6e-83a5-4d69-9c12-c351f64150e5
Nandi, D.
89b4a04e-5bff-4833-ba6e-52a1a8aba507
Wang, S.
a2223997-9f42-425b-b0c6-1bcb64d9b8fc
Liu, X.
878efcac-76c6-4ca0-8f4a-425f1e9abdac
Joint, C.
423119d0-8e94-47a6-8155-5245f6d4a144
Bain, P.G.
6f63e03e-9273-426e-adc0-72eb1bec9e63
Gregory, R.
fb588148-f426-4235-bbc4-8caeefd82c5a
Stein, J.
060b38b3-f84f-4c31-a1e0-c388eac92628
Aziz, T.Z.
728d8821-5fa0-407f-a09f-5a52038ad170

Bittar, R.G., Hyam, J., Nandi, D., Wang, S., Liu, X., Joint, C., Bain, P.G., Gregory, R., Stein, J. and Aziz, T.Z. (2005) Thalamotomy versus thalamic stimulation for multiple sclerosis tremor. Journal of Clinical Neuroscience, 12 (6), 638-642. (doi:10.1016/j.jocn.2004.09.008).

Record type: Article

Abstract

Disabling intractable tremor occurs frequently in patients with multiple sclerosis (MS). There is currently no effective medical treatment available, and the results of surgical intervention have been variable. Thalamotomy has been the mainstay of neurosurgical therapy for intractable MS tremor, however the popularisation of deep brain stimulation (DBS) has led to the adoption of chronic thalamic stimulation in an attempt to ameliorate this condition. With the goal of examining the relative efficacy and adverse effects of these two surgical strategies, we studied twenty carefully selected patients with intractable MS tremor. Thalamotomy was performed in 10 patients, with chronic DBS administered to the remaining 10. Both thalamotomy and thalamic stimulation produced improvements in postural and intention tremor. The mean improvement in postural tremor at 16.2 months following surgery was 78%, compared with a 64% improvement after thalamic stimulation (14.6 month follow-up) (P > 0.05). Intention tremor improved by 72% in the group undergoing thalamotomy, a significantly larger gain than the 36% tremor reduction following DBS (P < 0.05). Early postoperative complications were common in both groups. Permanent complications related to surgery occurred in four patients overall. Following thalamotomy, long-term adverse effects were observed in three patients (30%), and comprised hemiparesis and seizures. Only one patient in the thalamic stimulation group experienced a permanent deficit (monoparesis). We conclude that thalamotomy is a more efficacious surgical treatment for intractable MS tremor, however the higher incidence of persistent neurological deficits in patients receiving lesional surgery may support the use of DBS as the preferred surgical strategy.

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More information

Published date: August 2005
Keywords: deep brain stimulation, thalamotomy, multiple sclerosis, tremor
Organisations: Human Sciences Group

Identifiers

Local EPrints ID: 49603
URI: https://eprints.soton.ac.uk/id/eprint/49603
ISSN: 0967-5868
PURE UUID: 2763cae5-0d68-4175-a7dc-445eea0a11fc

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Date deposited: 21 Nov 2007
Last modified: 13 Mar 2019 20:53

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