Session Information
Date: Wednesday, September 25, 2019
Session Title: Surgical Therapy
Session Time: 1:15pm-2:45pm
Location: Les Muses Terrace, Level 3
Objective: To look at whether DBS programming to create a long field of stimulation in the thalamus-zona inserta (ZI) area is more effective, than traditional ways of programming in suppressing multiple sclerosis tremor.
Background: Whilst it is well established that deep brain stimulation is highly effective for the suppression of some tremor conditions such as essential, dystonic and parkinsonian tremor, its effect in multiple sclerosis (MS) related tremor is less impressive and it is often used as a palliative procedure to facilitate patient’s care . Further more, the effect of thalamic DBS in MS has been reported to wear off with time 1, 2. However, the development of the long 8 contact leads has helped to create larger fields of stimulation. This technology could theoretically be used to simulate a ‘big thalamic lesion’ to control large amplitude, proximal tremors.
Method: We retrospectively looked at the outcomes of patients in our centre that had undergone thalamic/ZI DBS for MS tremor, using an 8 lead contact and in which this approach of programming was adopted, either because the traditional single area monopolar or bipolar setting was ineffective from the start or because efficacy wore off with time. The Fahn-Tolosa-Marin tremor rating score (FTM) scores at baseline and at 12 months after switching to the above stimulation settings were studied. Four patients underwent this approach, 3-5 years postoperatively. Good tremor suppression was achieved in all 4, with an improvement range of 19-48 % on the FTM, and with demonstrable functional gain.
Results: Four patients underwent this approach of programming, 3-5 years postoperatively. Good tremor suppression was achieved in all 4, with an improvement range of 19-48 % on the FTM, and with demonstrable functional gain.
Conclusion: A long field of stimulation in the thalamic and zona inserta areas can improve efficacy of DBS in treating MS related tremor.
References: 1. Bilateral stimulation of the caudal zona incerta nucleus for tremor control. Plaha P1, Khan S, Gill SS. J Neurol Neurosurg Psychiatry. 2008 May;79(5):504-13. 2. Surgical therapy for multiple sclerosis tremor: a 12-year follow-up study. Hassan A, Ahlskog JE, Rodriguez M, Matsumoto JY. Eur J Neurol. 2012 May;19(5):764-8.
To cite this abstract in AMA style:
S. Alusi, B. Hammersley, J. Somerset, P. Eldridge, J. Farah. The concept of a ‘long lesion’ in thalamic/Zona inserta DBS for MS tremor suppression [abstract]. Mov Disord. 2019; 34 (suppl 2). https://www.mdsabstracts.org/abstract/the-concept-of-a-long-lesion-in-thalamic-zona-inserta-dbs-for-ms-tremor-suppression/. Accessed June 14, 2025.« Back to 2019 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/the-concept-of-a-long-lesion-in-thalamic-zona-inserta-dbs-for-ms-tremor-suppression/