Thalamotomy to treat MS related tremor

    
      Re: Thalamotomy to treat MS related tremor
    


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Posted by CCF Neuro MD on June 21, 1997 at 16:27:23:

In Reply to: Thalamotomy to treat MS related tremor posted by Don on June 14, 1997 at 01:30:28:

: has MS. After  10yrs. of relative health the  the past 3 yrs have become more and  more difficult. Susan has a terrible tremor affecting her right hand and more and more the entire right side of her body. We have resently learned about surgical intervention for her problem. I would appreciate if you could tell me more about the safety and success of thalamotomy for MS related tremor.  Sue is 35 and has tried many drugs to no avail. We need some help.
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Don:
Ventrolateral thalamotomy is a stereotaxic ("keyhole") neurosurgery in which a specific part of an important structure in the brain called the thalamus is electrically destroyed. Over the past several years, this procedure has been used as a "last resort" treatment for intractible tremor resulting from a variety of causes, namely Parkinson's disiease, essential tremor, cerebellar tremor, post-traumatic tremor, MS etc. The greatest experience has been with its use in Parkinson's disease. It is an effective operation, abolishing or significantly improving the tremor in 50-80% of cases, depending upon the disorder, severity, etc. Complications, however, are frequent. A bilateral procedure is very rarely performed due to a prohibitively high frequency of complications. Hence, its use is essentially for the treatment of a predominantly unilateral tremor.
Experience with the use of this procedure in MS related tremor is more limited. Although effective in reducing tremor, it less commonly leads to a significant functional improvement in the MS patient.
There are two recent variations to the procedure. The thalamotomy can be performed using the Gamma Knife, i.e. with focussed radiation without using surgery. More importantly, tremor can also be controlled by thalamic stimulation using implanted microelectrodes (i.e. without causing permanent damage to the structure). The latter procedure was pioneered in France and in Switzerland, and a few institutions in the US specializing in movement disorders perform it too.
Thalamic stimulation is reversible and apparently safer than thalamotomy.
From your description, Susan may be a suitable candidate for one of the procedures.
I would suggest that Susan begin the evaluation by seeing a neurologist specializing in movement disorders. If you live near Cleveland, you could see Dr. R.S.Burns from the Department of Neurologyat the Cleveland Clinic.
This information is provided for general medical educational purposes only. Please consult your physician for diagnostic and treatment options of your specific medical condition.