Objective: To evaluate the therapeutic effect of electrical chronic stimulation of ventralis oralis posterior and zona incerta (VOP/ZI) in 3 subjects affected by severely disabling and medication resistant mixed tremor due to multiple sclerosis (MS).

Background: Deep Brain stimulation (DBS) has proven effective in case of severely disabling and medication resistant MS tremor. Historically, the most common DBS target is unilateral or bilateral stimulation of the thalamic nucleus ventralis intermedius (Vim), while few papers report the effect of combined VOP/ZI stimulation.

Methods: Two patients affected by MS-related invalidating and medication resistant mixed tremor of the upper limb were submitted to unilateral DBS of the VOP/ZI and one patient to bilateral procedure. In all the three procedures one electrode was used to reach both targets.

Results: Clinical follow up ranges from 6 month (patient 1) to one year and three years (patient 2 and 3 respectively). Post-operative imaging demonstrated the correct positioning of the electrode within both VOP/ZI. No surgical complications have been observed. In all cases an immediate post-operative improvement of the tremor was noticed, confirmed by a concomitant score reduction of the Fahn-Tolosa-Marin Tremor Rating Scale. Such benefit persists at the last follow up visit for all patients.

Conclusions: Combined DBS of VOP/ZI represents a valid and safe therapeutic option for medication resistant MS tremor.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/vopzi-deep-brain-stimulation-for-the-relief-of-tremor-in-multiple-sclerosis/