Tiefe Hirnstimulation für Multiple-Sklerose-assoziierten Tremor

C. Wille; A. Schnitzler; J. Vesper

doi:10.1055/s-0028-1090215

Aktuelle Neurologie, Table of Contents

Aktuelle Neurologie 2009; 36: S19-S23
DOI: 10.1055/s-0028-1090215

Übersicht

Tiefe Hirnstimulation für Multiple-Sklerose-assoziierten Tremor

Deep Brain Stimulation for Multiple Sclerosis-Associated TremorC. Wille¹ , A. Schnitzler² , J. Vesper¹

¹Neurochirurgie, Universitätsklinikum Düsseldorf
²Institut für Klinische Neurologie und medizinische Psychologie, Universitätsklinikum Düsseldorf

Abstract

Zusammenfassung

Seit 2 Jahrzehnten werden Tremorerkrankungen mit der thalamischen tiefen Hirnstimulation (DBS) behandelt. Die Datenlage für die DBS beim Multiple Sklerose (MS)-Tremor ist gekennzeichnet von Studien niedriger Evidenzklasse mit kleinen Patientenzahlen, kurzen Verlaufsbeobachtungen sowie ungenauen Angaben zum funktionellen Ergebnis und zur Langzeiteffektivität. Es gibt keine verlässlichen Outcomeprädiktoren und somit keine sicheren Kriterien zur Patientenselektion. Der kurzfristige und insbesondere der langfristige Therapieerfolg sind schwer vorhersagbar. Derzeit ist die DBS zur Behandlung des MS-Tremors weiterhin als Ultima-Ratio-Therapie anzusehen. Bei einem niedrigen Risikoprofil, der geringen Effektivität anderer Therapiemaßnahmen und der großen Bedeutung des Tremors für den Grad der Behinderung kann unter Beachtung der anerkannten Kontraindikationen ein entsprechender Therapieversuch mit jedem betroffenen Patienten diskutiert werden.

Abstract

Tremor became an indication for thalamic deep brain stimulation (DBS) more than two decades ago. Today DBS is an established treatment option for essential tremor and Parkinson's tremor according to controlled and randomized trails. Current data regarding DBS for MS-associated tremor lack an equivalent evidence level. Even though patients with multiple sclerosis-associated tremor (MS-tremor) were among the fist cases reported, little is known about proper patient selection, therapeutic efficacy, long-term outcome and safety. Low patient numbers, short follow-up times, lack of functional data characterize most reports. Therapeutic success remains poorly predictable and therefore DBS for MS-tremor is a last resort indication. The urgent need for controlled and randomized studies to clarify this status is apparent.

Schlüsselwörter

Tremor - Multiple Sklerose - tiefe Hirnstimulation - DBS

Key words

tremor - multiple sclerosis - deep brain stimulation - DBS

Full Text

References

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Dr. med. Christian Wille

Universitätsklinikum Düsseldorf – Neurochirurgie

Moorenstr. 5

40225 Düsseldorf

Email: christian.wille@med.uni-duesseldorf.de