Stereotactic thalamotomy was first used to treat patients with tremor due to multiple sclerosis (MS) in 1958. This article reviews the subsequent literature on thalamotomy together with the use of thalamic stimulators. A critical review of results and methodology is presented, with particular attention directed at four areas: patient selection, preoperative patient evaluation, operative procedure and results, and postoperative follow-up. Unfortunately much of the literature is deficient in one or more of these areas. Confirmation of either a diagnosis of MS or variant of MS disease was often not given, and preoperative descriptions of both the patients' tremor and general clinical status were often limited. Targets for stereotactic ablation generally covered the thalamic ventrolateral nuclear complex, although the subthalamic nucleus and thalamic reticular nuclei also had lesions. Physiological refinement of target locus was used in over half of the published series. Immediate and short-term abolition or significant reduction of tremor was reported in 92percnt; of patients. Where data were available, sim;70percnt; of patients still had reduced tremor 12 months after surgery. However, the functional status of many of these patients was not improved. Side effects associated with stereotactic thalamotomy varied considerably between series, but the 30-day mortality rate was 1percnt;. Five patients have had thalamic stimulators implanted with promising early results. Exacerbation of MS by the thalamic surgery was not reported. Because the literature on thalamic surgery for tremor in MS patients is highly variable in quality, recommendations concerning factors to be considered in the design and reporting of similar clinical trials and series are made. Stereotactic thalamic surgery for tremor due to MS could possibly undergo a resurgence if newer immunomodulatory agents can arrest or retard the progress of the disease.
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