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Title: Clinical evaluation of thalamic deep brain stimulation for movement disorders in multiple sclerosis
Author: Hooper, Julie Ellen
Awarding Body: University of Edinburgh
Current Institution: University of Edinburgh
Date of Award: 2001
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The work presented here had 3 principal objectives: first to develop and validate a scale for measuring movement disorders in MS (MDMS); secondly to evaluate the effect of thalamic DBS on impairment, disability, handicap and aspects of quality of life (QOL) relevant to these patients; and thirdly to estimate the costs associated with thalamic DBS. The Modified Fahn's Tremor Rating Scale (MFTRS) was developed and validated for the purposes of this study. Results of the validity, reliability and responsiveness of the MFTRS, as given in the published paper, showed that it can be used with confidence in the clinical setting. Thirty seven patients with MDMS were assessed before operation. Fifteen patients underwent thalamic surgery. The target arm was assessed 1, 3, 6 and 12 months after operation using the MFTRS, which measured severity of tremor, and the Jebsen Test of Hand Function (JTHF) which measured performance of 7 subtests of upper limb function. Information concerning the influence of the movement disorder on overall disability, handicap and QOL was collected at or over 12 months and was compared with that of the pre-operative assessment using various subjective rating scales and questionnaires. Results showed that thalamic DBS significantly reduced the severity of tremor amplitude and significantly improved performance of the Jebsen subtests when the DBS was on at each post-operative assessments (1, 3, 6, and 12 months) compared with pre-operatively (all p values < 0.02). However, these symptomatic and changes in function did not translate into significant improvements in patients' performance in activities of daily living and thus there were no apparent economic benefits (ie. savings in future care-costs). Also there was no change in patients' perceptions of their handicap or in most aspects of QOL: the only significant change was that patients perceived themselves to be less anxious 12 months after the operation (p=0.03). The overall impact was therefore clinically limited. This prospective study has illustrated the benefits and limitations of thalamic DBS in patients with MDMS, and has highlighted the post-operative rehabilitation and follow-up requirements and the resulting health economic implications associated with its use. The validation of the MFTRS not only enabled the effect of thalamic DBS to be evaluated but also provided a major contribution to the assessment of MDMS.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available