Multiple sclerosis surgery: Difference between revisions
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When drugs are not effective enough surgery may be recommended. Further damage to the nerve to prevent the transmission of pain (Rhyzotomy) has proven its efficacy;<ref>{{cite journal |author=Kondziolka D, Lunsford LD, Bissonette DJ |title=Long-term results after glycerol rhizotomy for multiple sclerosis-related trigeminal neuralgia |journal=The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques |volume=21 |issue=2 |pages=137-40 |year=1994 |pmid=8087740 |doi=}}</ref> | When drugs are not effective enough surgery may be recommended. Further damage to the nerve to prevent the transmission of pain (Rhyzotomy) has proven its efficacy;<ref>{{cite journal |author=Kondziolka D, Lunsford LD, Bissonette DJ |title=Long-term results after glycerol rhizotomy for multiple sclerosis-related trigeminal neuralgia |journal=The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques |volume=21 |issue=2 |pages=137-40 |year=1994 |pmid=8087740 |doi=}}</ref> | ||
however the beneficial effects and risks in multiple sclerosis patients of those procedures that consist in relieving the pressure on the nerve are still under discussion.<ref>{{cite journal |author=Athanasiou TC, Patel NK, Renowden SA, Coakham HB |title=Some patients with multiple sclerosis have neurovascular compression causing their trigeminal neuralgia and can be treated effectively with MVD: report of five cases |journal=British journal of neurosurgery |volume=19 |issue=6 |pages=463-8 |year=2005 |pmid=16574557|doi=10.1080/02688690500495067}}</ref><ref>{{cite journal |author=Eldridge PR, Sinha AK, Javadpour M, Littlechild P, Varma TR|title=Microvascular decompression for trigeminal neuralgia in patients with multiple sclerosis |journal=Stereotactic and functional neurosurgery |volume=81 |issue=1-4 |pages=57-64 |year=2003 |pmid=14742965 |doi=10.1159/000075105}}</ref> | however the beneficial effects and risks in multiple sclerosis patients of those procedures that consist in relieving the pressure on the nerve are still under discussion.<ref>{{cite journal |author=Athanasiou TC, Patel NK, Renowden SA, Coakham HB |title=Some patients with multiple sclerosis have neurovascular compression causing their trigeminal neuralgia and can be treated effectively with MVD: report of five cases |journal=British journal of neurosurgery |volume=19 |issue=6 |pages=463-8 |year=2005 |pmid=16574557|doi=10.1080/02688690500495067}}</ref><ref>{{cite journal |author=Eldridge PR, Sinha AK, Javadpour M, Littlechild P, Varma TR|title=Microvascular decompression for trigeminal neuralgia in patients with multiple sclerosis |journal=Stereotactic and functional neurosurgery |volume=81 |issue=1-4 |pages=57-64 |year=2003 |pmid=14742965 |doi=10.1159/000075105}}</ref> | ||
===Tremor and ataxia=== | |||
If all these measures fail some patients are candidates for [[thalamus]] [[surgery]]. This kind of surgery can be both a[[thalamotomy]] or the implantation of a [[thalamic stimulator]]. Complications are frequent (30% in thalamotomy and 10% in deep brain stimulation) and include a worsening of ataxia, [[dysarthria]] and [[hemiparesis]]. | |||
Thalamotomy is a more efficacious surgical treatment for intractable MS tremor, however the higher incidence of persistent neurological deficits in patients receiving lesional surgery supports the use of deep brain stimulation as the preferred surgical strategy.<ref>{{cite journal |author=Bittar RG, Hyam J, Nandi D, Wang S, Liu X, Joint C, Bain PG, Gregory R, Stein J, Aziz TZ|title=Thalamotomy versus thalamic stimulation for multiple sclerosis tremor |journal=Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia |volume=12 |issue=6 |pages=638-42 |year=2005 |pmid=16098758|doi=10.1016/j.jocn.2004.09.008}}</ref> | |||
Revision as of 14:51, 27 August 2012
Trigeminal neuralgia
When drugs are not effective enough surgery may be recommended. Further damage to the nerve to prevent the transmission of pain (Rhyzotomy) has proven its efficacy;[1] however the beneficial effects and risks in multiple sclerosis patients of those procedures that consist in relieving the pressure on the nerve are still under discussion.[2][3]
Tremor and ataxia
If all these measures fail some patients are candidates for thalamus surgery. This kind of surgery can be both athalamotomy or the implantation of a thalamic stimulator. Complications are frequent (30% in thalamotomy and 10% in deep brain stimulation) and include a worsening of ataxia, dysarthria and hemiparesis.
Thalamotomy is a more efficacious surgical treatment for intractable MS tremor, however the higher incidence of persistent neurological deficits in patients receiving lesional surgery supports the use of deep brain stimulation as the preferred surgical strategy.[4]
- ↑ Kondziolka D, Lunsford LD, Bissonette DJ (1994). "Long-term results after glycerol rhizotomy for multiple sclerosis-related trigeminal neuralgia". The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques. 21 (2): 137–40. PMID 8087740.
- ↑ Athanasiou TC, Patel NK, Renowden SA, Coakham HB (2005). "Some patients with multiple sclerosis have neurovascular compression causing their trigeminal neuralgia and can be treated effectively with MVD: report of five cases". British journal of neurosurgery. 19 (6): 463–8. doi:10.1080/02688690500495067. PMID 16574557.
- ↑ Eldridge PR, Sinha AK, Javadpour M, Littlechild P, Varma TR (2003). "Microvascular decompression for trigeminal neuralgia in patients with multiple sclerosis". Stereotactic and functional neurosurgery. 81 (1–4): 57–64. doi:10.1159/000075105. PMID 14742965.
- ↑ Bittar RG, Hyam J, Nandi D, Wang S, Liu X, Joint C, Bain PG, Gregory R, Stein J, Aziz TZ (2005). "Thalamotomy versus thalamic stimulation for multiple sclerosis tremor". Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia. 12 (6): 638–42. doi:10.1016/j.jocn.2004.09.008. PMID 16098758.