Tiefe Hirnstimulation für Multiple-Sklerose-assoziierten Tremor

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

Literatur

• 1 Hein T, Hopfenmuller W. Projection of the number of multiple sclerosis patients in Germany.  Nervenarzt. 2000;  71 288-294
• 2 Weinshenker B G, Issa M, Baskerville J. Long-term and short-term outcome of multiple sclerosis: a 3-year follow-up study.  Arch Neurol. 1996;  53 353-358
• 3 Liu X, Miall C, Aziz T Z. et al . Analysis of action tremor and impaired control of movement velocity in multiple sclerosis during visually guided wrist-tracking tasks.  Mov Disord. 1997;  12 992-999
• 4 Tranchant C, Bhatia K P, Marsden C D. Movement disorders in multiple sclerosis.  Mov Disord. 1995;  10 418-423
• 5 Alusi S H, Worthington J, Glickman S. et al . A study of tremor in multiple sclerosis.  Brain. 2001;  124 720-730
• 6 Kandel E I, Hondcarian O A. Surgical treatment of the hyperkinetic form of multiple sclerosis.  Acta Neurol (Napoli). 1985;  7 345-347
• 7 Deuschl G, Bain P, Brin M. Consensus statement of the Movement Disorder Society on Tremor.  Ad Hoc Scientific Committee Mov Disord. 1998;  13 (Suppl. 3) 2-23
• 8 Yerdelen D, Karatas M, Goksel B. et al . A patient with multiple sclerosis presenting with Holmes' tremor.  Eur J Neurol. 2008;  15 e2-e3
• 9 Pittock S J, McClelland R L, Mayr W T. et al . Prevalence of tremor in multiple sclerosis and associated disability in the Olmsted County population.  Mov Disord. 2004;  19 1482-1485
• 10 Alusi S H, Glickman S, Aziz T Z. et al . Tremor in multiple sclerosis.  J Neurol Neurosurg Psychiatry. 1999;  66 131-134
• 11 Liu X, Miall R C, Aziz T Z. et al . Distal versus proximal arm tremor in multiple sclerosis assessed by visually guided tracking tasks.  J Neurol Neurosurg Psychiatry. 1999;  66 43-47
• 12 Liu X, Ingram H A, Palace J A. et al . Dissociation of „on-line” and „off-line” visuomotor control of the arm by focal lesions in the cerebellum and brainstem.  Neurosci Lett. 1999;  264 121-124
• 13 Lang E J, Rosenbluth J. Role of myelination in the development of a uniform olivocerebellar conduction time.  J Neurophysiol. 2003;  89 2259-2270
• 14 Feys P, Maes F, Nuttin B. et al . Relationship between multiple sclerosis intention tremor severity and lesion load in the brainstem.  Neuroreport. 2005;  16 1379-1382
• 15 Nakashima I, Fujihara K, Okita N. et al . Clinical and MRI study of brain stem and cerebellar involvement in Japanese patients with multiple sclerosis.  J Neurol Neurosurg Psychiatry. 1999;  67 153-157
• 16 Hickman S J, Brierley C M, Silver N C. et al . Infratentorial hypointense lesion volume on T1-weighted magnetic resonance imaging correlates with disability in patients with chronic cerebellar ataxia due to multiple sclerosis.  J Neurol Sci. 2001;  187 35-39
• 17 Nakamura R, Kamakura K, Tadano Y. et al . MR imaging findings of tremors associated with lesions in cerebellar outflow tracts: report of two cases.  Mov Disord. 1993;  8 209-212
• 18 Herzog J, Hamel W, Wenzelburger R. et al . Kinematic analysis of thalamic versus subthalamic neurostimulation in postural and intention tremor.  Brain. 2007;  130 1608-1625
• 19 Clanet M G, Brassat D. The management of multiple sclerosis patients.  Curr Opin Neurol. 2000;  13 263-270
• 20 Cooper I S. Neurosurgical alleviation of intention tremor of multiple sclerosis and cerebellar disease.  N Engl J Med. 1960;  263 441-444
• 21 Brice J, McLellan L. Suppression of intention tremor by contingent deep-brain stimulation.  Lancet. 1980;  1 1221-1222
• 22 Benabid A L, Pollak P, Gao D. et al . A Chronic electrical stimulation of the ventralis intermedius nucleus of the thalamus as a treatment of movement disorders.  J Neurosurg. 1996;  84 203-214
• 23 Kiss Z H, Mooney D M, Renaud L. et al . Neuronal response to local electrical stimulation in rat thalamus: physiological implications for mechanisms of deep brain stimulation.  Neuroscience. 2002;  113 137-143
• 24 Anderson T R, Hu B, Iremonger K. et al . Selective attenuation of afferent synaptic transmission as a mechanism of thalamic deep brain stimulation-induced tremor arrest.  J Neurosci. 2006;  26 841-850
• 25 Plaha P, Khan S, Gill S S. Bilateral stimulation of the caudal zona incerta nucleus for tremor control.  J Neurol Neurosurg Psychiatry. 2008;  79 504-513
• 26 Riechert T, Richter D. Surgical treatment of multiple sclerosis tremor and essential tremor.  Munch Med Wochenschr. 1972;  114 2025-2028
• 27 Arsalo A, Hanninen A, Laitinen L. Functional neurosurgery in the treatment of multiple sclerosis.  Ann Clin Res. 1973;  5 74-79
• 28 Mundinger F, Kuhn I. Postoperative and long-term results after stereotactic operations for action myoclonia in cases of encephalomyelitis disseminata.  Appl Neurophysiol. 1982;  45 299-305
• 29 Speelman J D, Van Manen J. Stereotactic thalamotomy for the relief of intention tremor of multiple sclerosis.  J Neurol Neurosurg Psychiatry. 1984;  47 596-599
• 30 Hitchcock E, Flint G A, Gutowski N J. Thalamotomy for movement disorders: a critical appraisal.  Acta Neurochir Suppl (Wien). 1987;  39 61-65
• 31 Whittle I R, Haddow L J. CT guided thalamotomy for movement disorders in multiple sclerosis: problems and paradoxes.  Acta Neurochir Suppl. 1995;  64 13-16
• 32 Alusi S H, Aziz T Z, Glickman S. et al . Stereotactic lesional surgery for the treatment of tremor in multiple sclerosis: a prospective case-controlled study.  Brain. 2001;  124 1576-1589
• 33 Geny C, Nguyen J P, Pollin B. et al . Improvement of severe postural cerebellar tremor in multiple sclerosis by chronic thalamic stimulation.  Mov Disord. 1996;  11 489-494
• 34 Montgomery Jr E B, Baker K B, Kinkel R P. et al . Chronic thalamic stimulation for the tremor of multiple sclerosis.  Neurology. 1999;  53 625-628
• 35 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;  97 815-820
• 36 Hooper J, Taylor R, Pentland B. et al . A prospective study of thalamic deep brain stimulation for the treatment of movement disorders in multiple sclerosis.  Br J Neurosurg. 2002;  16 102-109
• 37 Schulder M, Sernas T J, Karimi R. Thalamic stimulation in patients with multiple sclerosis: long-term follow-up.  Stereotact Funct Neurosurg. 2003;  80 48-55
• 38 Bittar R G, Hyam J, Nandi D. et al . Thalamotomy versus thalamic stimulation for multiple sclerosis tremor.  J Clin Neurosci. 2005;  12 638-642
• 39 Schuurman P R, Bosch D A, Bossuyt P M. et al . A comparison of continuous thalamic stimulation and thalamotomy for suppression of severe tremor.  N Engl J Med. 2000;  342 461-468
• 40 Schuurman P R, Bosch D A, Merkus M P. et al . Long-term follow-up of thalamic stimulation versus thalamotomy for tremor suppression.  Mov Disord. 2008;  23 1146-1153
• 41 Koch M, Mostert J, Heersema D. et al . Tremor in multiple sclerosis.  J Neurol. 2007;  254 133-145
• 42 Nguyen J P, Degos J D. Thalamic stimulation and proximal tremor. A specific target in the nucleus ventrointermedius thalami.  Arch Neurol. 1993;  50 498-500
• 43 Siegfried J, Lippitz B. Chronic electrical stimulation of the VL-VPL complex and of the pallidum in the treatment of movement disorders: personal experience since 1982.  Stereotact Funct Neurosurg. 1994;  62 71-75
• 44 Whittle I R, Hooper J, Pentland B. Thalamic deep-brain stimulation for movement disorders due to multiple sclerosis.  Lancet. 1998;  351 109-110
• 45 Hay O D. Thalamic deep brain stimulation for treatment of visual symptoms in multiple sclerosis.  Clinical Eye and Vision Care. 1999;  11 121-131
• 46 Schulder M, Sernas T, Mahalick D. et al . Thalamic stimulation in patients with multiple sclerosis.  Stereotact Funct Neurosurg. 1999;  72 196-201
• 47 Taha J M, Janszen M A, Favre J. Thalamic deep brain stimulation for the treatment of head, voice, and bilateral limb tremor.  J Neurosurg. 1999;  91 68-72
• 48 Matsumoto J, Morrow D, Kaufman K. et al . Surgical therapy for tremor in multiple sclerosis: an evaluation of outcome measures.  Neurology. 2001;  57 1876-1882
• 49 Nandi D, Chir M, Liu X. et al . Electrophysiological confirmation of the zona incerta as a target for surgical treatment of disabling involuntary arm movements in multiple sclerosis: use of local field potentials.  J Clin Neurosci. 2002;  9 64-68
• 50 Wishart H A, Roberts D W, Roth R M. et al . Chronic deep brain stimulation for the treatment of tremor in multiple sclerosis: review and case reports.  J Neurol Neurosurg Psychiatry. 2003;  74 1392-1397
• 51 Nandi D, Aziz T Z. Deep brain stimulation in the management of neuropathic pain and multiple sclerosis tremor.  J Clin Neurophysiol. 2004;  21 31-39
• 52 Foote K D, Seignourel P, Fernandez H H. et al . Dual electrode thalamic deep brain stimulation for the treatment of posttraumatic and multiple sclerosis tremor.  Neurosurgery. 2006;  58 ONS-5
• 53 Lim D A, Khandhar S M, Heath S. et al . Multiple target deep brain stimulation for multiple sclerosis related and poststroke Holmes' tremor.  Stereotact Funct Neurosurg. 2007;  85 144-149
• 54 Hyam J A, Aziz T Z, Bain P G. Post-deep brain stimulation – gradual non-stimulation dependent decrease in strength with attenuation of multiple sclerosis tremor.  J Neurol. 2007;  254 854-860
• 55 Hamel W, Herzog J, Kopper F. et al . Deep brain stimulation in the subthalamic area is more effective than nucleus ventralis intermedius stimulation for bilateral intention tremor.  Acta Neurochir (Wien). 2007;  149 749-758
• 56 Liu X, Aziz T Z, Miall R C. et al . Frequency analysis of involuntary movements during wrist tracking: a way to identify ms patients with tremor who benefit from thalamotomy.  Stereotact Funct Neurosurg. 2000;  74 53-62
• 57 Bain P G, Findley L J, Atchison P. et al . Assessing tremor severity.  J Neurol Neurosurg Psychiatry. 1993;  56 868-873
• 58 Alusi S H, Worthington J, Glickman S. et al . Evaluation of three different ways of assessing tremor in multiple sclerosis.  J Neurol Neurosurg Psychiatry. 2000;  68 756-760
• 59 Fahn S, Tolosa E, Marin C. Clinical rating scale for tremor. In: Jancovic J, Tolosa E, eds Parkinson's Disorders, 2^nd ed. Baltimore; Williams & Wilkins 1988: 225-234
• 60 Hooper J, Taylor R, Pentland B. et al . Rater reliability of Fahn's tremor rating scale in patients with multiple sclerosis.  Arch Phys Med Rehabil. 1998;  79 1076-1079
• 61 Krauss J K, Simpson Jr R K, Ondo W G. et al . Concepts and methods in chronic thalamic stimulation for treatment of tremor: technique and application.  Neurosurgery. 2001;  48 535-541