Results by motor cortex stimulation in treatment of focal dystonia, Parkinson’s disease and post-ictal spasticity. The experience of the Italian Study Group of the Italian Neurosurgical Society

Pagni, C. A.; Albanese, Alberto; Bentivoglio, Anna Rita; Broggi, Giovanni; Canavero, Sergio; Cioni, Beatrice; Rose, Marisa De; Simone, Clara De; Franzini, Angelo; Lavano, Angelo; Landi, Andrea; Meglio, Mario; Modugno, M.; Romanelli, Luiz Cláudio Ferreira; Romito, Luigi; Sturiale, Carmelo Lucio; Valzania, Franco; Zeme, Sergio Mario; Zenga, Francesco

doi:10.1007/978-3-211-78205-7_3

Cited by 37 publications

(30 citation statements)

References 34 publications

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“…The magnitude of the effects, the exact location of the stimulation electrode and best technique of implantation of DBS leads into this nucleus are still being debated (Aravamuthan et al, 2007(Aravamuthan et al, , 2008(Aravamuthan et al, , 2009Weinberger et al, 2008;Fu et al, 2009;Shimamoto et al, 2010). There have also been several small experimental trials of extradural motor cortex stimulation in human patients (Benvenuti et al, 2006;Strafella et al, 2007;Cilia et al, 2007Cilia et al, , 2008Arle et al, 2008;Lefaucheur, 2009;Pagni et al, 2008). This procedure results in small improvements of motor performance, and reductions in dyskinesias and psychiatric symptoms, perhaps mostly because of reductions in medication requirements.…”

Section: New Targets For Dbs In Pdmentioning

confidence: 99%

Parkinson's Disease Therapeutics: New Developments and Challenges Since the Introduction of Levodopa

Smith

Wichmann

Factor

et al. 2011

Neuropsychopharmacol

194

137

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The demonstration that dopamine loss is the key pathological feature of Parkinson's disease (PD), and the subsequent introduction of levodopa have revolutionalized the field of PD therapeutics. This review will discuss the significant progress that has been made in the development of new pharmacological and surgical tools to treat PD motor symptoms since this major breakthrough in the 1960s. However, we will also highlight some of the challenges the field of PD therapeutics has been struggling with during the past decades. The lack of neuroprotective therapies and the limited treatment strategies for the nonmotor symptoms of the disease (ie, cognitive impairments, autonomic dysfunctions, psychiatric disorders, etc.) are among the most pressing issues to be addressed in the years to come. It appears that the combination of early PD nonmotor symptoms with imaging of the nigrostriatal dopaminergic system offers a promising path toward the identification of PD biomarkers, which, once characterized, will set the stage for efficient use of neuroprotective agents that could slow down and alter the course of the disease.

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Section: New Targets For Dbs In Pdmentioning

confidence: 99%

Parkinson's Disease Therapeutics: New Developments and Challenges Since the Introduction of Levodopa

Smith

Wichmann

Factor

et al. 2011

Neuropsychopharmacol

194

137

View full text Add to dashboard Cite

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“…The topography and extension of the somatotopic representations within the motor cortex showed modification in advanced PD with progressive enlargement and displacement of hand motor map; this can explain the improvement of axial symptoms with plate electrode implanted over the motor strip at the hand knob [5]. Bilateral effects of unilateral MCS are due to bidirectional interconnectivity between motor cortex and other neural structures located in the cortex, basal ganglia, and thalamus.…”

Section: Discussionmentioning

confidence: 98%

“…Chronic MCS has been used not only in relieving refractory pain but also in improving a variety of movement disorders including PD, tremor, and poststroke dystonia [2,4,5,9,[12][13][14][15][16][17]. Single case reports, multicenter retrospective clinical review and small case series of advanced PD patients treated with EMCS have been reported with variable clinical results [1-4, 6-9, 16].…”

Section: Discussionmentioning

confidence: 99%

“…However, STN DBS appears to be more effective on motor symptoms while MCS on axial symptoms [4,5,16,28,30,31]. Complication rate and adverse events are low for extradural MCS [31][32][33].…”

Section: Discussionmentioning

confidence: 99%

“…Recently, other minimal invasive neuromodulation procedures with low morbidity-mortality and more suitable for cases excluded from DBS or unresponsive to DBS could be considered. Among these, motor cortex stimulation (MCS) may be one of the new opportunities [1][2][3][4] [5]. He showed that any symptom was modulated by MCS without a clear predictability.…”

Section: Introductionmentioning

confidence: 99%

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Motor Cortex Stimulation for Parkinson's Disease

SpringerReference

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Motor Cortex Stimulation (MCS) is less efficacious than Deep Brain Stimulation (DBS) inParkinson'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 onmedication states and after surgery at 1, 3, 6, 12, 18, 24, and 36 months in on-medication/on-stimulation and off-medication/onstimulation 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.

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