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Thalamic stimulation in multiple sclerosis: evidence for a ‘demyelinative thalamotomy’

Department of Pathology and Laboratory Medicine (Neuropathology), University of British Columbia, Vancouver, Canada, wayne.moore{at}vch.ca, International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, Canada

Aleksander M Vitali

Division of Neurosurgery, University of British Columbia, Vancouver, Canada

Esther Leung

Department of Pathology and Laboratory Medicine (Neuropathology), University of British Columbia, Vancouver, Canada

Cornelia Laule

Department of Radiology, University of British Columbia, Vancouver, Canada, UBC MRI Research Centre, University of British Columbia, Vancouver, Canada

Piotr Kozlowski

UBC MRI Research Centre, University of British Columbia, Vancouver, Canada

Alex L MacKay

Department of Radiology, University of British Columbia, Vancouver, Canada, UBC MRI Research Centre, University of British Columbia, Vancouver, Canada, Department of Physics and Astronomy, University of British Columbia, Vancouver, Canada

Christopher R Honey

Division of Neurosurgery, University of British Columbia, Vancouver, Canada

The mechanism of action of deep brain stimulation (DBS) in the alleviation of tremor in multiple sclerosis (MS) and other neurological disorders is unknown. Moreover, whether the trauma accompanying this surgery is responsible for the induction of new MS plaques is controversial. Here we report the first description of the post-mortem imaging and pathologic findings in the brain of a MS patient who underwent thalamic DBS for the treatment of MS-induced tremor. MR imaging of formalin-fixed brain slices was carried out at 1.5, 3 and 7 Tesla and correlated with the histopathology. There were numerous demyelinative plaques in the white mater, cortex and deep gray matter. There were no plaques along the DBS tract within the sections that sampled the deep hemispheric white matter. However, deep within the thalamus focal demyelination approximated the tract, particularly in the region corresponding to the electrical field. The findings in this single case raise the possibility that focal demyelination may be induced by the electrical field and this may be responsible for long-lasting alleviation of tremor in the absence of continued electrostimulation.

Key Words: multiple sclerosis • deep brain stimulation • demyelination • MRI

This version was published on November 1, 2009

Multiple Sclerosis, Vol. 15, No. 11, 1311-1321 (2009)
DOI: 10.1177/1352458509345914


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