Objective: The objective of our study is to report the evidence on the effectiveness and safety of Deep Brain Stimulation (DBS) in managing upper extremity tremors in Multiple Sclerosis (MS) patients.

Background: MS patients often experience Holmes tremor, a debilitating condition that can severely impact a patient’s quality of life. When tremors affect the upper extremities, they make it challenging to perform daily activities such as eating, drinking, writing, and dressing. While medical management is commonly used to control tremors, it has not been effective for all MS tremor patients. The effectiveness of DBS in managing tremors has made a popular treatment option for Parkinson’s disease, essential tremor, and dystonia. While some studies have shown deep brain stimulation (DBS) to be a successful treatment for tremors control in MS patients, its use is not approved due to lack of sufficient evidence.  The findings of the study can add to the evidence that DBS is effective and safe in managing tremors in patients with MS.

Method: We present a case series of 9 patients with MS tremors who underwent DBS at Virginia Mason Medical Center from 2006 to 2022 for severe tremor or medication resistant tremor. Eight patients had unilateral DBS and one patient had bilateral DBS. A retrospective chart review was performed to extract patient details and descriptive statistics were used for analysis.

Results: Six (66.67%) female and three (33.33%) male patients had undergone DBS for MS tremor management. The target for DBS stimulation was the ventral intermediate nucleus (VIM) of the thalamus. On average, DBS programming was initiated approximately eight days after lead placement. Tremor level was subjectively assessed by a neurologist when patients performed motor tasks. After adjusting stimulation parameters, patients in the study experienced 50-100% reduction in tremor. During the follow-up visit, upper extremity tremor improvement was seen in 88.89% (N-8) patients. There was no incidence of morbidity and mortality  after the DBS procedure.

Conclusion: The findings of our study suggest DBS to be safe and effective in controlling MS tremor. DBS can thus be considered as a tremor treatment option in this population if pharmacotherapy and occupational therapy fails to improve the MS tremor.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/deep-brain-stimulation-for-multiple-sclerosis-tremors-a-case-series/