Thalamotomy is a more efficacious surgical treatment for intractable multiple sclerosis (MS) tremor: Video Case report (ORP-06)

Background: Tremor is a common symptom of MS, the predominant type of MS tremor is a high amplitude, postural and kinetic, intention tremor, rubral tremor or Holmes’s tremor (midbrain tremor). In MS tremors commonly affect the arms, but can also involve the head, neck, vocal cords and trunk. In the majority of MS patients , tremor is mild. Bilateral arm involvement and titubation were seen in 9% of MS patients and is severely disabling and embarrassing features of MS, tremor in MS could be as advanced consequence of the disease, and suggest a more aggressive course, patients with in capacitating tremors were more likely to be unemployed or to have a retired early. Intention tremor severity affects activities of daily living such as drinking, hand writing, personal computer interaction, and has psychological and social impact of the tremor on patient and his family.
Treatment of tremors in MS: physical aids, Lifestyle changes, limb cooling, weight bracelets, Orthoses, physiotherapy, pharmacotherapy, Botulinum toxin, and surgery.
Surgical treatment in MS tremor: In disabling cases that fail to benefit from several different medications, deep brain stimulation (DBS), and stereotactic thalamotomy are both comparable procedures for suppression of severe and disabling tremor, the tremor reduction immediately after surgery.
Objective: A 35 – y – old woman a known ease of MS from 5 years’ ago, refer with sever and embarrassing tremor in dominant hand, that interfered with dilly activities, and fail to benefit from other treatment for MS tremor, for patient. A thalamotomy was performed and intention tremor improved immediately, after Thalamotomy early postoperative complications like seizure and hemiparesis was not occur and for fallow up of long- term advers effects patient has not refer.
Conclusion: Thalamotomy is a more efficacious surgical treatment for intractable MS tremor.