Deep brain stimulation

Deep brain stimulation is sometimes used to treat serious tremor in multiple sclerosis (MS).

Deep brain stimulation involves surgery to permanently implant electrodes in the area of the brain called the thalamus. A battery is implanted near the collarbone.  This sends pulsed messages to the electrodes that block the nerve messages that are believed to cause tremor.

Deep brain stimulation was originally developed for Parkinson's disease. There have been few studies of the long-term effects in MS.  The studies that have taken place found it worked in around 85% of people.  However, the effects of treatment were short lived with symptoms returning within three to six months after surgery.

The operation itself carries some risks. A small number of people have a brain haemorrhage during the surgery, and there is the risk of infection, as with all invasive surgery.  There is also the chance of developing significant new symptoms, such as speech and swallowing disorders, and balance problems.

Deep brain stimulation tends to be used only for very disabling tremor.

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.
Summary (link is external)
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.
Summary (link is external)
Mandat T, et al.
Thalamic deep brain stimulation for tremor among multiple sclerosis patients.
Neurologia i Neurochirurgia Polska 2010;44(6):542-545.
Summary (link is external)
Thevathasan W, et al
Permanent tremor reduction during thalamic stimulation in multiple sclerosis.
Journal of Neurology Neurosurgery and Psychiatry 2011;82(4):419-422.
Summary (link is external)
Hassan A, et al.
Surgical therapy for multiple sclerosis tremor: a 12-year follow-up study.
European Journal of Neurology 2012;19(5):764-768.
Summary (link is external)
Hosseini H, et al.
Unilateral thalamic deep brain stimulation for disabling kinetic tremor in multiple sclerosis.
Neurosurgery 2012;70(1):66-69.
Summary (link is external)
Oliveria SF 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 Sep;16(9):691-700. doi: 10.1016/S1474-4422(17)30166-7. Epub 2017 Jun 20.
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