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BACKGROUND: Surgical options of multiple sclerosis (MS) tremor treatment are limited and narrowed to thalamotomy or deep brain stimulation (DBS) of the thalamic nucleus ventralis intermedius (Vim). Lack of qualification protocol frequently results in poor outcome.
OBJECTIVE: To determine prospectively the efficacy and safety of unilateral Vim DBS as a tool to control disabling kinetic arm tremor related to MS.
METHODS: Neurological and neuropsychological evaluations were performed one month and one day before surgery, and 1, 3 and 6 months after surgery. The evaluation included measurement of tremor, dexterity, EDSS, MMSE and Quality of Life (QOL). Nine consecutive patients were enrolled in the group. Mean age at the time of surgery was 38.9+/- 9 years, median EDSS at baseline was 7.1. Mean MS duration was 11.7 years and mean tremor duration was 6.11 years. Mean postural and kinetic scores and hand capacity was measured.
RESULTS: One month after surgery, median scores OFF and ON were respectively 12 and 6 for postural tremor; 12 and 10.5 for kinetic tremor score; 12 and 7.5 for manual capacity; 22 and 20 for functional handicap. Similar results were respectively 10 and 4 at three months follow-up. Six months after surgery, median scores OFF and ON were respectively 10.4 and 4 for postural tremor, 12 and 7.8 for kinetic tremor.
CONCLUSION: This prospective study confirms the value and safety of Vim DBS for treatment of kinetic tremor related to MS. Accurate and precise presurgical qualification plays the key role in successful treatment.
Full article access for Neurosurgery subscribers at Neurosurgery-Online.com.
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