Multiple sclerosis (MS) is a chronic autoimmune disease in which the immune system attacks the myelin sheath that covers and protects nerve fibers in the central nervous system, leading to a range of neurological symptoms. Multiple sclerosis (MS) is more common in women than in men, with a ratio of about 3:1. It is estimated that approximately 2.5 million people worldwide have MS [1]. The symptoms include fatigue, numbness or tingling sensations in the arms, legs, face, or other parts of the body, muscle weakness or stiffness, blurred or double vision, loss of coordination or balance, difficulty walking or standing, tremors or involuntary muscle movements, cognitive problems, such as difficulty concentrating or remembering information, emotional changes, such as depression or mood swings, and bowel or bladder problems. Surgery is done to correct coordination symptoms for tremors and issues with balance and walking in some patients with multiple sclerosis [1].
Hassan et al. discuss outcomes and patient recovery after undergoing surgery for tremors associated with multiple sclerosis (MS). Hassan et al. found that both thalamotomy and deep brain stimulation (DBS) are effective in reducing tremors in patients with MS, with minimal difference in efficacy between the two techniques. Thalamotomy severs nerve fibers in the thalamus to correct movement disorders while deep brain stimulation implants electrodes within the brain to manage neuronal connections and treat tremors. Patients who underwent the DBS procedure experienced fewer adverse effects and required fewer revisional procedures. It was found that both techniques significantly reduced tremors in patients which is a debilitating symptom of MS [2].
Adams et al. discuss “strabismus surgery for internuclear ophthalmoplegia with exotropia in multiple sclerosis”. Internuclear ophthalmoplegia (INO) is a condition where the eyes have difficulty moving together due to damage in the brainstem, while exotropia refers to an outward deviation of the eyes. The optical muscles become paralyzed leading to double vision. While ocular dysfunction affects 70% of patients, 40% of patients have severe ocular challenges like INO and exotropia due to MS. Adams et al. explain that strabismus surgery fixes the alignment of the eyes through muscle surgery, but many doctors hesitate to perform the procedure. When done successfully, it corrects exotropia, improving eye alignment and reducing double vision. On the other hand, INO is a condition caused by damage to the brainstem and it is too risky to intervene surgically at the root of the condition. Adams et al. include case reports of successful operations in three patients with advanced progressive MS. MS affects multiple organs in the body and visual symptoms are often overlooked despite their impact on the sufferer’s quality of life [3].
Spinal injury is a severe MS-associated condition. These injuries affect up to 54.3% of patients and the spinal injuries include cervical myelopathy, cervical radiculopathy, and degenerative lumbar pathologies. Steinle et al. examine surgery to treat this while assessing the long-term efficacy based on readmission rates – the extended lifespan of a modern-day person with multiple sclerosis allows for degeneration in the same region to recur. Steinle et al. compare a non-surgical approach like pharmaceutical agents to surgical intervention, and they concluded that both patient groups (surgical and nonsurgical) reported improvement in pain and functionality. Thus, Steinle et al. recommend a strong evaluation of patients before surgery, since the risks of readmission and complications like dehiscence are at least 50% higher than taking a non-surgical approach [4].
References
1. Oh J, Vidal-Jordana A, Montalban X. Multiple sclerosis: clinical aspects. Curr Opin Neurol. 2018 Dec;31(6):752-759. doi: 10.1097/WCO.0000000000000622. PMID: 30300239.
2. Hassan A, Ahlskog JE, Rodriguez M, Matsumoto JY. Surgical therapy for multiple sclerosis tremor: a 12-year follow-up study. Eur J Neurol. 2012 May;19(5):764-8. doi: 10.1111/j.1468-1331.2011.03626.x. Epub 2012 Jan 17. PMID: 22248187.
3. Adams WE, Leavit JA, Holmes JM. Strabismus surgery for internuclear ophthalmoplegia with exotropia in multiple sclerosis. J Amer Assoc Ped Ophthalmology Strabismus 2009;13(1):13-15.
4. Steinle AM, Nian H, Pennings JS, Bydon M, Asher A, Archer KR, Gardocki RJ, Zuckerman SL, Stephens BF, Abtahi AM. Complications, readmissions, reoperations and patient-reported outcomes in patients with multiple sclerosis undergoing elective spine surgery – a propensity matched analysis. Spine J 2022;22(11):1820-1829. doidoi: 10.1016/j.spinee.2022.06.009.