Artikel
Retrospective multi-center analysis of long term outcome of DBS for Tremor in multiple sclerosis
Retrospektive multizentrische Analyse über Langzeitverläufe bei MS-Tremor-Patienten nach Tiefenhirnstimulation
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Autoren
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C. Wille
- Klinik für Neurochirurgie, Universitätsklinikum Düsseldorf
| Veröffentlicht: | 30. Mai 2008 |
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Gliederung
Text
Für die Arbeitsgemeinschaft Tiefe Hirnstimulation
Objective: Thalamic deep brain stimulation is an established treatment option for tremor in multiple sclerosis. Efficacy und advantages over lesional approaches have been demonstrated. However published studies lack long-term follow-up and patient numbers are rather small. Outcome predictors are not defined. Aim of this study of the German Arbeitsgemeinschaft Tiefe Hirnstimulation was to collect patients of German DBS centers to evaluate a large patient group retrospectively regarding long-term outcome and risk profile.
Methods: For this analysis patients of DBS centers in Kiel, Cologne, Düsseldorf, Bonn, Berlin, Freiburg, Munich, Kassel and Aachen were included. During site visits data was acquired concerning preoperative state, surgical procedure, postoperative outcome and complications. Tremor scales, quality of life scales, EDSS, stimulation parameters and medication were analyzed as far as available.
Results: So far 89 cases have been included. Maximum follow-up in rare cases is 9-10 years. Mean follow-up is 38 months. As anticipated data quality is heterogeneous. Target for DBS in all cases was the ventral intermediate nucleus (VIM). Higher EDSS values preoperatively seem to be associated with a bad functional postoperative outcome. Rates for surgical complications like infection and surgery related MS progression were much lower than expected. Trends for positive predictors could be identified.
Conclusions: Data from a large group of patients has been acquired. However the statistical value remains limited due to heterogeneity of data quality and retrospective approach. Experiences gained regarding the evaluation of treatment success could prove to be useful for still necessary prospective trails.
