Date Presented 04/03/2025
A 41-year old woman with multiple sclerosis (MS) underwent deep brain stimulation to reduce tremor. Tremor reduction was accompanied by improvements in grip strength, fine motor control, and dexterity. As a result, the individual’s independence in activities in daily living (ADLs) and instrumental activities of daily living (IADL) increased.
Primary Author and Speaker: Nicole J. Tester
Contributing Authors: Natasha Neyra, Abigail Corriveau, Mayra Montalvo Perero, Justin Hilliard
PURPOSE: Multiple sclerosis (MS) tremor can be severely debilitating. Due to its complex nature, conservative suppression (e.g. weighting) is not always effective. Deep brain stimulation (DBS) can reduce MS tremor. We explored the impact of DBS (left ventral intermediate thalamus) on improving functional use of the contralateral hand. Strategies to optimize independence in daily activities are critical given disability progression across the lifespan.
DESIGN: Quantitative case study with pre- versus post-outcomes in a 41-year old female (diagnosed at age 30) with severe right hand-dominant tremor and ataxia and moderate tremor and dysmetria in the non-dominant, left hand.
METHOD: Grip strength via dynamometer and scores on the 9-hole peg and functional dexterity tests were collected pre- and post-DBS. Associated changes in functional performance were identified with qualitative interview.
RESULTS: Tremor reduction was associated with improvements in grip strength, fine motor control, and dexterity in the dominant hand as early as 3 months after stimulation. By 9 months post-stimulation, a 27.9 pound increase in grip strength, 26 point improvement in functional dexterity, and 32 second improvement in fine motor control were observed. Interview revealed the individual had returned to driving, cooking, playing the piano, and handwriting for the first time in many years.
CONCLUSION: The impact DBS had on reducing tremor resulted in substantial gains in functional use of the dominant hand. This significantly impacted this individual’s independence in daily activities, quality of life, and mental health.
IMPACT STATEMENT: When conservative treatment of tremor failed in an individual with MS, DBS resulted in a 99% subjective improvement in hand function, participation in daily activities, and quality of life. Occupational therapists can educate and encourage individuals to explore and advocate for all treatment considerations with their physician.
References
Luitel, P., Neupane, N., Paudel, S., Adhikari, N., Timilsina, B., Suryabanshi, A., Gyawali, P., & Ojha, R. (2023). Prevalence and clinical types of tremor in multiple sclerosis and its associated disability: A systematic review. Tremor and Other Hyperkinetic Movements, 13(1), 1–7. https://doi.org/10.5334/tohm.776
Makhoul, K., Ahdab, R., Riachi, N., Chalah, M. A., & Ayache, S. S. (2020). Tremor in multiple sclerosis-An overview and future perspectives. Brain Sciences, 10(10), 722. https://doi.org/10.3390/brainsci10100722
