Objective: To report long-term outcome measurements of tremor control in patients with medically refractory multiple sclerosis tremor and dual lead thalamic deep brain stimulation.

Background: Multiple Sclerosis (MS) tremor is typically pharmacoresistant and disabling. Studies of treatment outcomes with stereotactic lesioning or single-lead deep brain stimulation (DBS) have been variable. Dual-lead thalamic DBS targeting the ventralis intermedius (VIM) and ventralis oralis (VO) has been shown to be a safe and effective therapy. Currently there is limited data on long-term outcomes of dual-lead thalamic DBS for tremor management. We report long-term outcomes in a cohort of patients with medically refractory MS tremor treated with dual-lead thalamic DBS.

Methods: Retrospective review of 19 patients with medically refractory tremor who underwent dual-lead thalamic DBS from 2007-2015. In this study 15 patients were included who were evaluated using the Tolosa-Fahn-Marin Tremor Rating Scale (TRS) before surgery and on-stimulation at 1, 3, and 5 years postoperatively.

Results: Median total TRS scores improved from baseline during a five-year follow-up (p=0.026). Median TRS motor scores were reduced from baseline during this period (p=0.044). No statistically significant differences were found in TRS activities of daily living (ADL) scores postoperatively compared to pre-surgical baseline (p=0.212).

Conclusions: Dual-lead thalamic DBS is potentially an effective treatment for the long-term improvement of severe, medication refractory tremor in MS. Although there is an improvement in motor scores, the disability questionnaire components remained unchanged from baseline.

References: Oliveria SF, Rodriguez RL, Bowers D, et al. Safety and efficacy of dual-lead thalamic deep brain stimulation for patients with treatment-refractory multiple sclerosis tremor: a single-centre, randomised, single-blind, pilot trial. Lancet Neurol. 2017;16(9):691-700. doi:10.1016/S1474-4422(17)30166-7.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/longitudinal-follow-up-of-dual-lead-thalamic-deep-brain-stimulation-for-patients-with-treatment-refractory-multiple-sclerosis-tremor/