The relief of postural and intention tremor of multiple sclerosis can be accomplished by infliction of a surgical lesion in the ventrolateral nucleus of the thalamus. The development of postural or intention tremor in such cases is secondary to a lesion of the cerebellodentato thalamic pathway, which results in impaired feedback of sensory communication from muscle spindles via cerebellum to the thalamus. A surgical lesion within ventrolateral thalamus abolishes communication of pathologic sensory information to the motor cortex, and thus relieves the tremor. In a series of 32 cases of intention tremor due to multiple sclerosis, the patients were subjected to thalamic surgery and followed up for one to ten years. The tremor was abolished or markedly lessened in 85% (27 of 32) of the patients in this series. There was one postoperative death; there are two patients with preexisting spastic hemiparesis who had worsening of spasticity following surgery. It is concluded that thalamic surgery is the treatment of choice of chronic or progressive intention tremor of multiple sclerosis.
Cooper IS. Relief of Intention Tremor of Multiple Sclerosis by Thalamic Surgery. JAMA. 1967;199(10):689–694. doi:10.1001/jama.1967.03120100051007
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