Functional neurosurgery for MS-related tremor

Epub: Hassan A, et al. Surgical therapy for multiple sclerosis tremor: a 12-year follow-up study. Eur J Neurol. 2012 Jan

Background and purpose: 
 Severe multiple sclerosis (MS) tremor causes disability poorly responsive to medication. Deep brain stimulation (DBS) or thalamotomy can suppress tremor, but long-term outcomes are unclear.

Methods:  Nine patients with MS tremor underwent disability measures at baseline and 12 months post-surgery (six thalamotomy, three DBS) in 1997-1998. We report the prospective 12-year follow-up of this cohort for tremor, disability, and death.

Results:  Surgery was initially successful in all. Tremor recurred in all patients within median 3 months, although two DBS patients were tremor-free for 5 years. Median tremor-free survival (tremor-free time/survival time) was 4.3%.

At 12-year follow-up, four survivors (two thalamotomy, two DBS) (Expanded Disability Status Scale scores 8-8.5) were severely disabled. Five patients were dead (four thalamotomy, one DBS) median 5.8 years post-operative.

Conclusions:  Surgery benefit for severe tremor was overall short-lived (median 3 months), with long-term poor prognosis. Although two DBS patients had sustained 5-year  tremor-suppression, the observed progressive disability and death in this cohort bear importance for long-term success in future MS tremor surgery trials.
This study high lights that whilst in some instances surgery can give a short term fix, as it is doing nothing to halt the disease process that in the longer-term such symptoms may return.

Please watch this video for more info on MS tremors:

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