Assessing tremor reduction and quality of life following thalamic deep brain stimulation for the treatment of tremor in multiple sclerosis
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《神经病学神经外科学杂志》
1 Surgical Centre for Movement Disorders, Division of Neurosurgery, University of British Columbia, Vancouver, BC, Canada
Correspondence to:
Dr C Berk
caglarberk@hotmail.com
Keywords: multiple sclerosis; tremor; quality of life
We read with interest the paper by Wishart et al.1 on chronic deep brain stimulation (DBS) for the treatment of tremor in multiple sclerosis. We would like to highlight two important points.
First, reduction in tremor should not be the ultimate goal of this surgery. It is a means to an end. The most important outcome for the patient must be improved function. Surgery that reduces tremor but does not improve limb function (for example, residual ataxia) is of questionable benefit for the patient, although surgeons may mistake it as "successful" if they only assess tremor. The authors’ review of the literature outlined many papers that focused on tremor but made no mention of function. In the authors’ own series of four patients, improvements in tremor "translated into improvements in aspects of daily functioning" but no details were provided on how this was measured. We addressed this point in a recent paper dealing with thalamic DBS for 12 patients with multiple sclerosis and tremor but unfortunately this was not included in the authors’ review.2
Second, the option of unilateral thalamic DBS in a patient with bilateral upper limb tremor should be discussed. We have found that, following DBS control of their dominant hand, some patients decide they do not need (or want) the other side done. If they have significant head tremor, however, bilateral surgery is required.3
References
Wishart HA, Roberts DW, Roth RM, et al. Chronic deep brain stimulation for the treatment of tremor in multiple sclerosis: review and case reports. J Neurol Neurosurg Psychiatry 2003;74:1392–7.
Berk C , Carr J, Sinden M, et al. Thalamic deep brain stimulation for the treatment of tremor due to multiple sclerosis: a prospective study of tremor and quality of life. J Neurosurg 2002;97:815–20.
Berk C , Honey CR. Bilateral thalamic deep brain stimulation for the treatment of head tremor: report of two cases. J Neurosurg 2002;96:615–18.
Author’s reply
H A Wishart2, D W Roberts2 and A J Saykin2
2 Neuropsychology Program and Brain Imaging Laboratory, Dartmouth Medical School/ DHMC, New Hampshire, USA
Correspondence to:
Dr H Wishart
Heather.A.Wishart@Dartmouth.EDU
Keywords: multiple sclerosis; tremor; quality of life
We value Dr Berk and colleagues’ commentary and their input on the relevance of assessing limb function and its implications for quality of life. Our manuscript was written before their important contribution1 appeared in our literature search, and we regret that it was not included in our
references. We targeted mainly English language outcome studies; an additional reference of note is that of Fernández-González and colleagues.2
References
Berk C , Carr J, Sinden M, et al. Thalamic deep brain stimulation for the treatment of tremor due to multiple sclerosis: a prospective study of tremor and quality of life. J Neurosurg 2002;97:815–20.
Fernández GF, Seijo F, Salvador C, et al. . Rev Neurol 2001;32:559–67.(C Berk1, J Carr1, M Sinde)
Correspondence to:
Dr C Berk
caglarberk@hotmail.com
Keywords: multiple sclerosis; tremor; quality of life
We read with interest the paper by Wishart et al.1 on chronic deep brain stimulation (DBS) for the treatment of tremor in multiple sclerosis. We would like to highlight two important points.
First, reduction in tremor should not be the ultimate goal of this surgery. It is a means to an end. The most important outcome for the patient must be improved function. Surgery that reduces tremor but does not improve limb function (for example, residual ataxia) is of questionable benefit for the patient, although surgeons may mistake it as "successful" if they only assess tremor. The authors’ review of the literature outlined many papers that focused on tremor but made no mention of function. In the authors’ own series of four patients, improvements in tremor "translated into improvements in aspects of daily functioning" but no details were provided on how this was measured. We addressed this point in a recent paper dealing with thalamic DBS for 12 patients with multiple sclerosis and tremor but unfortunately this was not included in the authors’ review.2
Second, the option of unilateral thalamic DBS in a patient with bilateral upper limb tremor should be discussed. We have found that, following DBS control of their dominant hand, some patients decide they do not need (or want) the other side done. If they have significant head tremor, however, bilateral surgery is required.3
References
Wishart HA, Roberts DW, Roth RM, et al. Chronic deep brain stimulation for the treatment of tremor in multiple sclerosis: review and case reports. J Neurol Neurosurg Psychiatry 2003;74:1392–7.
Berk C , Carr J, Sinden M, et al. Thalamic deep brain stimulation for the treatment of tremor due to multiple sclerosis: a prospective study of tremor and quality of life. J Neurosurg 2002;97:815–20.
Berk C , Honey CR. Bilateral thalamic deep brain stimulation for the treatment of head tremor: report of two cases. J Neurosurg 2002;96:615–18.
Author’s reply
H A Wishart2, D W Roberts2 and A J Saykin2
2 Neuropsychology Program and Brain Imaging Laboratory, Dartmouth Medical School/ DHMC, New Hampshire, USA
Correspondence to:
Dr H Wishart
Heather.A.Wishart@Dartmouth.EDU
Keywords: multiple sclerosis; tremor; quality of life
We value Dr Berk and colleagues’ commentary and their input on the relevance of assessing limb function and its implications for quality of life. Our manuscript was written before their important contribution1 appeared in our literature search, and we regret that it was not included in our
references. We targeted mainly English language outcome studies; an additional reference of note is that of Fernández-González and colleagues.2
References
Berk C , Carr J, Sinden M, et al. Thalamic deep brain stimulation for the treatment of tremor due to multiple sclerosis: a prospective study of tremor and quality of life. J Neurosurg 2002;97:815–20.
Fernández GF, Seijo F, Salvador C, et al. . Rev Neurol 2001;32:559–67.(C Berk1, J Carr1, M Sinde)