Multi-Lead Spinal Cord Stimulation for Control of Motor Disorders

Abstract

This report presents observations in 160 patients undergoing chronic spinal cord stimulation for various disorders of the motor system and compares the results obtained using older conventional two-electrode bipolar stimulation with a newly developed four-electrode multiple level system. Improvement was noted in 84% of the 75 patients with cerebral palsy, 67% of the 42 patients with dystonia, 62% of the 21 patients with torticollis and 73% of the 22 patients with post-traumatic neurologic loss. Significant improvements were noted when comparing the two-electrode system with the new multiple level electrode. Marked to moderately improved patients increased from 57 to 84% in cerebral palsy, from 44 to 82% in dystonia, from 53 to 75% in torticollis and from 53 to 80% in posttraumatic neurologic conditions. There was a corresponding marked drop in unimproved patients in each condition.

Long Term Results of Microsurgical Dorsal Root Entry Zonotomy for Upper Extremity Spasticity

“…Chronic cerebellar stimulation techniques were developed by Cooper 2) for cerebral palsy. Cervical spinal cord stimulation was developed for spinal spasticity by Cook and Weinstein 1) and for cerebral palsy by Waltz et al 20) . Chronic neurostimulation has very few indications at the present time.…”

Spinal Stimulation for Movement Disorders

“…The only double-blind clinical trial had a limited value because of the small sample size, but did not confirm any beneficial effect of SCS in dystonia [28]. Most studies involved patients suffering from spasmodic torticollis with a speculative mechanisms of action, relying on alteration of propriospinal fibers involved in the regulation of tonic reflexes of the neck, thus interrupting the tonic neck reflex pattern [22], or an action on the reticular activating system [30]. Cervical SCS for dystonia was progressively abandoned in the 1990s owing to the emerging successful use of botulinum toxin injection [31,32].…”

Spinal Cord Stimulation in the Treatment of Spasmodic Torticollis

“…Since, we have used a percutaneous technique (9,12) in which four electrodes are incorporated into a thin catheter system which can be inserted through a single 16-gauge epidural needle. The multielectrode assembly consists of four platinum elec trodes, 4 mm in length, 1.2 mm in diameter and spaced 6 mm apart (1 cm center to cen- …”

“…These observations led us that time to the design of a system which would allow stimulation at selected cord levels and at various frequencies. The result was a four-electrode system which subsequently was shown to improve the results of spinal cord stimulation in motor disorders [12]. These results were further im proved by introduction of a computerized system [15], which elimi nated percutaneous leads and a second stage operation for receiver im plantation, has resulted in a reduced risk of infection, and allows an in definite period for selection of the stimulation parameters which in the case of torticollis is extremely important.…”