Case Insights on Deep Brain Stimulation in MS Tremor and Parkinson Disease: Pamela Zeilman, NP

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"I showed a multiple sclerosis (MS) tremor case, and with MS tremor, [the response] is mixed. We know that some patients [with MS tremor] can benefit from [deep brain stimulation], but some have very minimal or no response. [The patient I selected] had a very hyperkinetic movement and tremor associated with her MS in the upper extremities that prevented her from eating and drinking. Her response was dramatic—before and after stimulation."

Deep brain stimulation (DBS) has become an established therapeutic option for a variety of movement disorders, including Parkinson disease (PD), essential tremor, and dystonia. By delivering targeted electrical stimulation to specific brain regions, DBS can help modulate abnormal neural circuits, reducing motor symptoms such as tremor, rigidity, and bradykinesia. Although traditionally considered for classic cases of PD or essential tremor, research and clinical experience have expanded its use to more complex or atypical presentations, demonstrating its potential to improve quality of life even in patients with challenging symptom profiles.

Clinical outcomes with DBS can vary depending on the disorder, symptom profile, and target selection. For example, patients with multiple sclerosis (MS)–related tremor may benefit from dual-lead implantation in the ventral intermediate nucleus and ventral oralis nucleus, though ataxia can limit the overall effect. In PD, young-onset patients with a mix of dystonia, bradykinesia, and gait freezing may respond differently to subthalamic nucleus versus globus pallidus internus targets. Evidence from studies suggests that each target could offer distinct advantages in terms of medication reduction, dyskinesia control, and mood, underscoring the importance of individualized treatment planning.

To explore this in more detail, NeurologyLive^® spoke with Pamela Zeilman, NP, who shared scenarios of using DBS across a range of movement disorders at the 4th Annual Advanced Therapeutics in Movement and Related Disorders (ATMRD) Congress, held by the PMD Alliance from June 27-30, 2025. Zeilman, nurse practitioner in the Center for Movement Disorders & Neurorestoration at the University of Florida, discussed specific patient cases, including MS tremor and PD, highlighting the practical considerations in target selection, stimulation settings, and anticipated outcomes. Her insights provided a nuanced perspective on how clinicians could approach DBS, balancing efficacy with patient-specific symptom profiles to achieve optimal results.

Click here for more coverage of ATMRD 2025.

REFERENCES
1. Zeilman P, Amjad F. DBS Advanced Techniques Case Review.Presented at: ATMRD; June 27-30, 2025; Washington, DC.