Brain 2001 Aug;124(Pt 8):1576-1589
Alusi SH, Aziz TZ, Glickman S, Jahanshahi
M, Stein JF, Bain PG.
Division of Neurosciences and Psychological
Medicine, Imperial College School of Medicine, Charing Cross Hospital Campus,
The Multiple Sclerosis Unit, North West London NHS Trust, Central Middlesex
Hospital, Department of Clinical Neurology Institute of Neurology, London
and University Department of Physiology, Oxford University, Oxford, UK.
The effect of stereotactic lesional
surgery for the treatment of tremor in multiple sclerosis was examined
in a prospective case-controlled study.
Surgery was not undertaken in 33
patients (72% of 46 cases referred for stereotactic surgery), two of whom
died within 4 months of referral.
Twenty-four multiple sclerosis patients
were included in the study; 13 underwent surgery and were matched against
11 controls on the basis of age, sex, expanded disability system scores
(EDSS) and disease duration.
Assessments were carried out at baseline/preoperatively,
and then 3 and 12 months later; these included accelerometric and clinical
ratings of tremor, spirography, handwriting, a finger-tapping test, nine-hole
peg test, tremor-related disability, general neurological examination,
Barthel Activities of Daily Living (ADL) Index of general disability, EDSS,
a 0-4 ataxia scale, Mini-Mental State (MMS) examination, speech and swallowing
assessments and grip strength.
Postoperative MRI scans demonstrated
that tremor could be attenuated by lesions centred on the thalamus in seven
cases, on the zona incerta in five cases and in the subthalamic nucleus
in one case.
Two patients developed hemiparesis
and in two cases epilepsy recurred.
Two surgical patients and one control
patient died between the 3 and 6 months assessments.
Both groups had a significant deterioration
in EDSS but not Barthel ADL Index scores at 1 year, but the difference
between the groups was not significant.
Similarly, no differences between
the groups' rates of deterioration of speech or swallowing or MMS were
found.
Significant improvements in contralateral
upper limb postural (P2) and kinetic tremors, spiral scores and head tremor
were detected at 3 and 12 months after surgery (but not handwriting or
nine-hole peg test performance).
Tremor-related disability and finger-tapping
speed were also significantly better 12 months after surgery, the latter
having significantly worsened for the control group.
A 3 Hz 'filter' for postural (P2)
upper limb tremor was detected by accelerometry/spectral analysis above
which tremor was always abolished and at or below which some residual tremor
invariably remained.
Criteria for selecting multiple sclerosis
patients for this form of surgery are discussed.
PMID: 11459749 [PubMed - as supplied
by publisher]