title: Thalamic deep brain stimulation for tremor among multiple sclerosis patients.
abstract: OBJECTIVE
  Disabling tremor might be the main cause of disability of multiple sclerosis (MS) patients. Neuromodulation with deep brain stimulation of the thalamic nucleus ventralis intermedius (Vim DBS) is a well accepted method of neurosurgical treatment of tremor related to essential tremor or Parkinson disease. Vim DBS is not widely used to control MS tremor.
  
  
  METHODS
  Five MS patients with tremor (3 females and 2 males) were treated with Vim DBS. Age at implantation was 37 ± 5 years. MS lasted from 5 to 12 years (mean 6) and tremor was the main cause of disability of those patients from 2 to 5 years (mean 3) before surgery. Clinical condition of the group was evaluated with spirography, the modified Fahn scale and the modified Activity of Daily Living (ADL) scale. Evaluations were performed before surgery and 3 months after surgery. MRI exclusion criteria were the presence of a thalamic hyperintense signal in T2-weight-ed images or ventricular enlargement. The procedures of implantation were performed under local and general anaesthesia.
  
  
  RESULTS
  Intensity of contralateral limb tremor during intraoperative macrostimulation was reduced in the whole group. The therapeutic effect of DBS was maintained at three-month follow-up. Mean contralateral limb tremor reduction was 40%. Mean ADL score improved by 18%. No mortality or morbidity was reported in the group.
  
  
  CONCLUSIONS
  The study confirms the value and safety of Vim DBS for treatment of MS-related tremor. Further study on a larger population and introduction of a qualification protocol might increase efficacy of the treatment.
authors.affiliation: Klinika Nowotworów Układu Nerwowego, Centrum Onkologii, Instytut im. Marii Skłodowskiej-Curie, ul. Roentgena 5, 02-781 Warszawa. tomaszmandat@yahoo.com
authors.forename: Tomasz
authors.initials: T
authors.lastname: Mandat
authors.forename: Henryk
authors.initials: H
authors.lastname: Koziara
authors.forename: Marcin
authors.initials: M
authors.lastname: Tutaj
authors.forename: Rafał
authors.initials: R
authors.lastname: Rola
authors.forename: Wiesław
authors.initials: W
authors.lastname: Bonicki
authors.forename: Paweł
authors.initials: P
authors.lastname: Nauman
mesh_terms: D000328:Adult; D046690:Deep Brain Stimulation / Q000295:instrumentation / Q000379:methods*; D004566:Electrodes; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications / Q000628:therapy*; D020656:Posterior Thalamic Nuclei; D016896:Treatment Outcome; D014202:Tremor / Q000209:etiology / Q000628:therapy*; D020651:Ventral Thalamic Nuclei