Zengrui Zhang *, Haiyan Tang *, Yang Li, Ying Tan

Department of Neurology, Huzhou Central Hospital, The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University, Huzhou, Zhejiang, 313000, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Ying Tan, Department of Neurology, Huzhou Central Hospital, The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University, Huzhou, Zhejiang, 313000, People’s Republic of China, Email zzftyzhy@126.com

Abstract: Multiple sclerosis (MS) tremors, which are a common cause of disability, do not always respond to pharmacological treatment. Contrastingly, deep brain stimulation (DBS) in the thalamic or subthalamic areas (especially in the zona incerta, ZI) has prompted a response in suppressing MS tremors. In this study, we searched the relevant literature to further investigate the positive and negative effects of using DBS planted in different brain areas to suppress MS tremors. The unique effects of GABAergic agents from the ZI pertain to both the basal ganglia thalamocortical and cerebellar thalamocortical loops, in addition to the brain stem motor effector, where tremor oscillation may be transmitted. From this, the ZI is an effective target for ameliorating MS tremors through surgical treatment. Stimulation of the ZI, even bilaterally, could better control MS tremors, and with fewer side effects than targeting the thalamic area. Thus, the ZI is a promising target for regulating MS tremors. This review on MS tremor suppression will help to further understand the benefits of DBS on the ZI compared to DBS on the thalamic area in terms of managing MS tremors.

Keywords: deep brain stimulation, multiple sclerosis, tremors, different targets