A to Z of MS Deep brain stimulation

Deep brain stimulation is a surgical technique used to treat serious intention tremor in multiple sclerosis. It is sometimes also known as stereotactic deep brain stimulation (stereotactic surgery is a minimally-invasive method that allows a surgeon access to structures within the brain) or thalamic deep brain stimulation (the thalamus is the area of the brain where the electrodes are placed).

Deep brain stimulation involves permanently implanting electrodes in selected parts of the brain. A battery is implanted near the collarbone and is connected by a thin wire, which sends pulsed messages to the electrodes. These block nerve impulses that are believed to cause tremor.

Deep brain stimulation has been found to be successful in restoring functional ability in around 85% of people who underwent the procedure. However, the procedure itself carries some risks. A small number of people experience a brain haemorrhage during the implantation, and there is the risk of developing significant new symptoms particularly speech and swallowing disorders, and balance disorders.

Deep brain stimulation was originally devised as a treatment option for Parkinson's Disease. It has only more recently been used in other conditions and there have been few studies of the long-term effects in MS.

One study followed five people with MS over five years following treatment for intention tremor in their arms. It found that the tremor was effectively suppressed over this period, however, their arms became progressively weaker over time. This weakness and loss of function persisted in two people even after the electrodes had been switched off. In another study, 11 people with MS tremor were treated with deep brain stimulation. Tremor was assessed before, within 1 year and within 3-5 years of treatment. Permanent tremor reduction was observed in 11 of 18 affected arms, and could occur when limb strength was preserved.

Deep brain stimulation tends to be viewed as an option only for significantly disabling tremor. It is available at some specialised neurosurgical units in the UK.

References

Yap L, et al.
Stereotactic neurosurgery for disabling tremor in multiple sclerosis: thalamotomy or deep brain stimulation?
British Journal of Neurosurgery 2007;21(4):349-354.
abstract

Hyam JA, et al.
Post-deep brain stimulation - gradual non-stimulation dependent decrease in strength with attenuation of multiple sclerosis tremor.
Journal of Neurology 2007;254(7):854-860.
abstract

Thevathasan W, Schweder P, Joint C, et al.
Permanent tremor reduction during thalamic stimulation in multiple sclerosis.
Journal of Neurology Neurosurgery and Psychiatry 2011;82(4):419-22.
abstract

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