EP 35. Deep brain stimulation for multiple sclerosis related tremor: Clinical reports

Abstract

Introduction Multiple sclerosis (MS), is a demyelinating disease in which the insulating covers of nerve cells in the brain and spinal cord are damaged. Tremor is an important cause of disability and poor quality of life amongst MS patients. MS induced tremors can be present in rest, in action, or increase during an intended movement. The first treatment option is pharmacotherapy. However, these tremors do not respond adequately to drug therapy. In these patients, deep brain stimulation has been proposed as a potential therapy. Objectives Our main objective was to assess the efficacy of DBS of the thalamic ventro- intermediate/ventro-oralis posterior (Vim/Vop) nucleus and posterior subthalamic area (PSA) in alleviating MS related tremor. Materials methods Four patients (3 female, 1 male) with a mean age of 32.7 years (range 20–46) underwent surgery. The median duration of MS prior to surgery was 10 years and median duration of tremor prior to surgery was 7 years. Case selection was by multidisciplinary assessment with neurosurgeons, movement disorder neurologists and psychiatrists. Tremor was scored preoperatively and at 3–12 months post operatively by using the Fahn Tolosa Marin tremor scale (FTMTS). the Extended Disability Status Scale (EDSS) was also used before and after surgery. Three Patients underwent unilateral placement of DBS of the PSA and 1 patient underwent bilateral placement of DBS of the thalamic Vim/Vop nucleus. Results The patients FTMTS scores was averaged 51 and EDSS scores was averaged 5.5 before surgery. It was observed average 40% reduction in postoperative FTMTS scores. Conclusion DBS may reduce severe, disabling tremor in patients with MS. Additionally,There is a need for further research on patient selection, target selection, and alternative treatments for MS tremor treatments.