Chronic deep brain stimulation for the treatment of tremor in multiple sclerosis

Review and case reports

H. A. Wishart, D. W. Roberts, R. M. Roth, B. C. McDonald, D. J. Coffey, Alexander Mamourian, C. Hartley, L. A. Flashman, C. E. Fadul, A. J. Saykin

Research output: Contribution to journalReview article

73 Citations (Scopus)

Abstract

Background: Deep brain stimulation (DBS) offers a non-ablative alternative to thalamotomy for the surgical treatment of medically refractory tremor in multiple sclerosis. However, relatively few outcomes have been reported. Objective: To provide a systematic review of the published cases of DBS use in multiple sclerosis and to present four additional patients. Methods: Quantitative and qualitative review of the published reports and description of a case series from one centre. Results: In the majority of reported cases (n=75), the surgical target for DBS implantation was the ventrointeromedial nucleus of the thalamus. Tremor reduction and improvement in daily functioning were achieved in most patients, with 87.7% experiencing at least some sustained improvement in tremor control postsurgery. Effects on daily functioning were less consistently assessed across studies; in papers reporting relevant data, 76.0% of patients experienced improvement in daily functioning. Adverse effects were similar to those reported for DBS in other patient populations. Conclusions: Few of the studies reviewed used highly standardised quantitative outcome measures, and follow up periods were generally one year or less. Nonetheless, the data suggest that chronic DBS often produces improved tremor control in multiple sclerosis. Complete cessation of tremor is not necessarily achieved, there are cases in which tremor control decreases over time, and frequent reprogramming appears to be necessary.

Original languageEnglish (US)
Pages (from-to)1392-1397
Number of pages6
JournalJournal of Neurology, Neurosurgery and Psychiatry
Volume74
Issue number10
DOIs
StatePublished - Oct 1 2003

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Deep Brain Stimulation
Tremor
Multiple Sclerosis
Therapeutics
Thalamus
Research Design
Outcome Assessment (Health Care)
Population

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology
  • Psychiatry and Mental health

Cite this

Wishart, H. A. ; Roberts, D. W. ; Roth, R. M. ; McDonald, B. C. ; Coffey, D. J. ; Mamourian, Alexander ; Hartley, C. ; Flashman, L. A. ; Fadul, C. E. ; Saykin, A. J. / Chronic deep brain stimulation for the treatment of tremor in multiple sclerosis : Review and case reports. In: Journal of Neurology, Neurosurgery and Psychiatry. 2003 ; Vol. 74, No. 10. pp. 1392-1397.
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Wishart, HA, Roberts, DW, Roth, RM, McDonald, BC, Coffey, DJ, Mamourian, A, Hartley, C, Flashman, LA, Fadul, CE & Saykin, AJ 2003, 'Chronic deep brain stimulation for the treatment of tremor in multiple sclerosis: Review and case reports', Journal of Neurology, Neurosurgery and Psychiatry, vol. 74, no. 10, pp. 1392-1397. https://doi.org/10.1136/jnnp.74.10.1392

Chronic deep brain stimulation for the treatment of tremor in multiple sclerosis : Review and case reports. / Wishart, H. A.; Roberts, D. W.; Roth, R. M.; McDonald, B. C.; Coffey, D. J.; Mamourian, Alexander; Hartley, C.; Flashman, L. A.; Fadul, C. E.; Saykin, A. J.

In: Journal of Neurology, Neurosurgery and Psychiatry, Vol. 74, No. 10, 01.10.2003, p. 1392-1397.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Chronic deep brain stimulation for the treatment of tremor in multiple sclerosis

T2 - Review and case reports

AU - Wishart, H. A.

AU - Roberts, D. W.

AU - Roth, R. M.

AU - McDonald, B. C.

AU - Coffey, D. J.

AU - Mamourian, Alexander

AU - Hartley, C.

AU - Flashman, L. A.

AU - Fadul, C. E.

AU - Saykin, A. J.

PY - 2003/10/1

Y1 - 2003/10/1

N2 - Background: Deep brain stimulation (DBS) offers a non-ablative alternative to thalamotomy for the surgical treatment of medically refractory tremor in multiple sclerosis. However, relatively few outcomes have been reported. Objective: To provide a systematic review of the published cases of DBS use in multiple sclerosis and to present four additional patients. Methods: Quantitative and qualitative review of the published reports and description of a case series from one centre. Results: In the majority of reported cases (n=75), the surgical target for DBS implantation was the ventrointeromedial nucleus of the thalamus. Tremor reduction and improvement in daily functioning were achieved in most patients, with 87.7% experiencing at least some sustained improvement in tremor control postsurgery. Effects on daily functioning were less consistently assessed across studies; in papers reporting relevant data, 76.0% of patients experienced improvement in daily functioning. Adverse effects were similar to those reported for DBS in other patient populations. Conclusions: Few of the studies reviewed used highly standardised quantitative outcome measures, and follow up periods were generally one year or less. Nonetheless, the data suggest that chronic DBS often produces improved tremor control in multiple sclerosis. Complete cessation of tremor is not necessarily achieved, there are cases in which tremor control decreases over time, and frequent reprogramming appears to be necessary.

AB - Background: Deep brain stimulation (DBS) offers a non-ablative alternative to thalamotomy for the surgical treatment of medically refractory tremor in multiple sclerosis. However, relatively few outcomes have been reported. Objective: To provide a systematic review of the published cases of DBS use in multiple sclerosis and to present four additional patients. Methods: Quantitative and qualitative review of the published reports and description of a case series from one centre. Results: In the majority of reported cases (n=75), the surgical target for DBS implantation was the ventrointeromedial nucleus of the thalamus. Tremor reduction and improvement in daily functioning were achieved in most patients, with 87.7% experiencing at least some sustained improvement in tremor control postsurgery. Effects on daily functioning were less consistently assessed across studies; in papers reporting relevant data, 76.0% of patients experienced improvement in daily functioning. Adverse effects were similar to those reported for DBS in other patient populations. Conclusions: Few of the studies reviewed used highly standardised quantitative outcome measures, and follow up periods were generally one year or less. Nonetheless, the data suggest that chronic DBS often produces improved tremor control in multiple sclerosis. Complete cessation of tremor is not necessarily achieved, there are cases in which tremor control decreases over time, and frequent reprogramming appears to be necessary.

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