Surgeries and Procedures for Multiple Sclerosis

Because there’s no cure for multiple sclerosis (MS), your doctor will try to manage your symptoms and slow the disease’s advance. To start, you may take a combination of drugs and go to physical therapy.

If medication doesn’t work or has side effects you can’t tolerate, your doctor might suggest surgery or another procedure. You might hear some of these operations referred to as functional neurosurgery. This is a broad term for procedures that alter the way parts of your nervous system function.

Baclofen Pump

Up to 80% of people with MS have spasticity. That's when signals between your brain and your muscles get scrambled, making your muscles stiffen up. Spasticity can make it hard to walk, speak, and swallow. You could also have spasms that are painful or disturb your sleep. Eventually, it may limit your range of motion.

One drug that treats spasticity is a muscle relaxant called baclofen. If oral drugs don't work for you, you might get an intrathecal baclofen pump. (This approach is also called ITB or intrathecal baclofen therapy.) Your doctor implants a pump under the skin of your belly. It's attached to a thin, flexible tube that carries the medication straight into the fluid of your spine.

To check whether the treatment is right for you, your doctor will do a test first. They'll insert a needle into your spine (called a spinal tap) and inject baclofen into your spinal fluid. After several hours, your doctor will know whether the medicine works.

You’ll need surgery under anesthesia to place the pump. That always poses some risk. Other possible complications include:

  • Infection at the site of surgery
  • A malfunctioning pump, which could lead to withdrawal symptoms when you suddenly stop getting the drug
  • An accidental overdose of baclofen

Advantages of ITB include:

  • Baclofen is more effective when it goes straight to your spinal fluid.
  • Your body gets a steady dose.
  • There are fewer side effects than when you take the medicine by mouth.
  • Your doctor can adjust the flow of medicine to change throughout the day.

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Deep Brain Stimulation

Tremors, in which your head, limbs, or body tremble or shake uncontrollably, affect up to 60% of people with MS. They can make it hard to eat or dress yourself. In severe cases, you might have trouble swallowing or speaking. Some people find tremors hard to handle emotionally.

This is a hard symptom to treat. Your doctor might have you try several different medications. If your case is serious or drugs don’t help, you might be able to get a procedure called deep brain stimulation (DBS).

In deep brain stimulation, a neurosurgeon puts electrodes in your brain. They implant a programmable device, a kind of controller, under the skin of your chest. A wire under the skin of your head and neck connects the controller to the electrodes. DBS sends electrical impulses that disrupt the brain activity that causes tremors.

DBS isn’t as effective for MS as for some other conditions. But it may still improve your symptoms. The risks include:

While your brain is being stimulated, you might have:

  • Loss of balance
  • Tingling in your face or limbs
  • Speech or vision problems

Rhizotomy

Some people with MS, less than 5%, have intense facial pain called trigeminal neuralgia, or TN. It’s often described as feeling like an electric shock. Simple acts such as touching your face, brushing your teeth, talking, or chewing might set it off. It can also happen for no reason.

If medication doesn’t relieve your TN, rhizotomy might help. In this procedure, your doctor destroys fibers in the trigeminal nerve in your head so it can no longer carry pain signals. Rhizotomy is an outpatient procedure. You’ll go home after a few hours in recovery.

Among the types of rhizotomy are:

  • Glycerin/glycerol, in which the doctor injects a chemical that destroys the nerve
  • Radiofrequency, which uses a special needle and electric current to burn the nerve fibers

Your pain might return when the nerve grows back, usually in 1-6 years. But you can get rhizotomy again. Facial numbness is a possible side effect. It's more likely if you get the radiofrequency version.

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Other Procedures

Neurosurgeons can do other procedures that may improve tremors or trigeminal neuralgia.

Radiosurgery, despite its name, is not surgery. The procedure uses focused radiation to target parts of the brain or nerves.

For trigeminal neuralgia, it uses radiation to damage the nerve fibers. It’s an outpatient procedure, and you won’t need anesthesia. It can take anywhere from 4 weeks to 8 months to feel the full effects. It’s the least invasive procedure you can have for TN.

To treat tremors, a neurosurgeon will send radiation to an area deep in your brain called the thalamus, which handles sensory messages.

Radiosurgery is also called the Gamma Knife, CyberKnife, or X-Knife.

Gastrostomy

Dysphagia, or trouble swallowing, is more common among people with advanced MS. But it can happen to anyone with the condition. If the nerves that control your mouth and throat are damaged or weakened, you might find it hard to drink or eat.

The condition can be serious for two reasons. First, you might not be getting the liquids and nutrients you need. Second, you run the risk of choking, which can send food particles into your lungs. That can lead to infection. Your doctor might recommend a procedure called percutaneous endoscopic gastrostomy, or PEG.

For PEG, a surgeon inserts a flexible feeding tube into your stomach through an opening in the skin of your upper abdomen. It’s often an outpatient procedure. Your doctor will numb the area and give you IV drugs to relax you. Once the tube is in place, you can get nutrients and liquids through it.

Possible complications include:

  • Leaking of stomach contents
  • Pain
  • Tube movement or clogs
WebMD Medical Reference Reviewed by Neha Pathak, MD on January 15, 2021

Sources

SOURCES:

Mayo Clinic: "Multiple Sclerosis."

National Multiple Sclerosis Society: "Definition of MS," "Medications," "Managing Spasticity in MS," "Baclofen," "Tremor," "Swallowing Problems."

National Multiple Sclerosis Society Clinical Bulletin: "Pain in Multiple Sclerosis. "

Cleveland Clinic: "Intrathecal Baclofen Pump."

UK Multiple Sclerosis Society: "About Tremor."

American Association of Neurological Surgeons: "Deep Brain Stimulation," Movement Disorders," "Stereotactic Radiosurgery."

Brain Sciences: "Deep-Brain Stimulation for Essential Tremor and Other Tremor Syndromes: A Narrative Review of Current Targets and Clinical Outcomes."

Johns Hopkins University: "Trigeminal Neuralgia Treatments."

Journal of Neurology, Neurosurgery and Psychiatry: "Functional lesional neurosurgery for tremor: a systematic review and meta-analysis."

UCSF Weill Institute for Neurosciences: "Trigeminal Neuralgia FAQ."

Swedish Health Services: "Essential Tremor."

UK Multiple Sclerosis Trust: "Percutaneous Endoscopic Gastrostomy."

American Society for Gastrointestinal Endoscopy: "Understanding Percutaneous Endoscopic Gastrostomy."

Ohio State Wexner Medical Center: "What is Functional Neurosurgery?"

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