Motor Cortex Stimulation in Parkinson's Disease

Abstract

Motor Cortex Stimulation (MCS) is less efficacious than Deep Brain Stimulation (DBS) in Parkinson's disease. However, it might be proposed to patients excluded from DBS or unresponsive to DBS. Ten patients with advanced PD underwent unilateral MCS contralaterally to the worst clinical side. A plate electrode was positioned over the motor cortex in the epidural space through single burr hole after identification of the area with neuronavigation and neurophysiological tests. Clinical assessment was performed by total UPDRS, UPDRS III total, UPDRS III-items 27–31, UPDRS IV, and UPDRS II before implantation in off-medication and on-medication states and after surgery at 1, 3, 6, 12, 18, 24, and 36 months in on-medication/on-stimulation and off-medication/on-stimulation states. We assessed changes of quality of life, throughout the Parkinson's disease quality of life scale (PDQoL-39), and the dose of anti-Parkinson's disease medications, throughout the Ldopa equivalent daily dose (LEDD). During off-medication state, we observed moderate and transitory reduction of total UPDRS and UPDRS total scores and significant and long-lasting improvement in UPDRS III items 27–31 score for axial symptoms. There was marked reduction of UPDRS IV score and LEDD. PDQL-39 improvement was also significant. No important complications and adverse events occurred.

The external globus pallidus: progress and perspectives

“…This idea is supported by the literature showing STN‐HFS is effective in suppressing abnormal activity in the motor cortex of patients with PD (Sabatini et al ., ; Payoux et al ., ; Haslinger et al ., ). Additionally, transcranial stimulation of the motor cortex is also efficacious in ameliorating motor symptoms of PD (Cioni, ; De Rose et al ., ; Broeder et al ., ) and levodopa‐induced dyskinesias (Ferrucci et al ., ). In summary, it is very likely that STN‐HFS alters the temporal structure and dynamics of a complex set of pathways within the entire cortico‐basal ganglia‐thalamocortical loop.…”

Deep Brain Stimulation: Expanding Applications

“… 32 – 34) It is possible that future procedures will incorporate multi-site modulation to address the full gamut of dopaminergic, axial, and cognitive impairments advanced PD patients endure. 11 , 32 , 35 – 39 ) It is certain that clinicians will need to keenly match patients' symptoms with known outcomes of a number of neuroanatomic targets, unilateral and bilateral stimulation, as well as various stimulatory parameters including frequency, intensity, pulse width, and constant-current vs. voltage-controlled stimulation. 40 – 43) …”

Neurostimulation for traumatic brain injury

“…Several studies resulted in promising reduction in PD symptoms assessed by the Unified Parkinson's Disease Rating Scale and reduced levodopa dosage. 18,31,116,142 However, others reported no major improvement in motor function. 26,137 Based on anecdotal reports showing improved motor function when stroke patients with chronic pain were treated by motor cortex stimulation, 61,149 an initial study using subthreshold epidural motor cortex stimulation on a hemiparetic stroke patient was performed.…”