Single arm prospective multicenter case series on the use of burst stimulation to improve pain and motor symptoms in Parkinson’s disease

Abstract

Background In this study we analyze new clinical data in the use of spinal cord stimulation (SCS) for the treatment of pain and motor symptoms in patients with Parkinson’s Disease (PD), as both a singular bioelectric therapy and as a salvage therapy after deep brain stimulation (DBS). Methods Fifteen patients were recruited and had percutaneous electrodes implanted at the level of the thoracic or cervical spine. Participants were set to one of three stimulation modes: continuous tonic stimulation, continuous Burst stimulation (40 Hz, 500 Hz, 1000 μs), or cycle mode (on time of 10–15 s, off time of 15–30 s) with Burst (40 Hz, 500 Hz, 1000 μs). Patients completed the Visual Analogue Scale (VAS), Unified Parkinson’s Disease Rating Scale, Self-Rating Depression Scale, Hamilton Depression Rating Scale, Profile of Mood State, 10-meter walking test, and the Timed Up and Go (TUG). Results All patients experienced significant improvement in VAS scores with a mean reduction of 59% across all patients. Patients who chose the cycling burst stimulation parameter had an average 67% reduction in VAS scores, as compared to the continuous burst parameter group, which had an average 48% reduction in VAS scores. Seventy-three percent of patients experienced improvement in the 10-meter walk, with an average improvement of 12%. Sixty-four percent of patients experienced clinically relevant improvements in the TUG, with an average improvement of 21%. Conclusions This study points to the potential utility of SCS to address both pain and certain aspects of motor symptoms in PD patients who have and have not received DBS therapy.

Non‐pharmacological therapies for pain management in Parkinson's disease: A systematic review

“…Twelve studies assessed pain as a primary outcome, while the remaining eight studies assessed pain as a secondary outcome. Among the studies assessing pain as a primary outcome, seven studies found a statistically significant effect ( p < .05) of the intervention comparing baseline to final follow‐up 21,29,34,36,37,41 . Among the studies assessing pain as a secondary outcome, only one study found a statistically significant effect of the intervention relative to control when considering baseline and follow‐up measurements 25 .…”

“…These 20 studies spanned five major techniques in the non‐pharmacological management of pain in PD, which include massage therapy, 23–25 acupuncture (non‐electrical 26,27 or electrical 28 ), exercise therapy 29,30 (including yoga 31 ), aquatic therapy, 32,33 or neuromodulation 34–42 (Table 1). The eligible articles consisted of three case reports or case series, eight RCTs, and nine non‐randomized interventional studies.…”

“…Evidence suggests that stimulation of particular regions within the basal ganglia (BG), such as the subthalamic nucleus (STN) and the globus pallidus (GP), can have beneficial outcomes in pain management of PD patients. Circuitry within the BG is known to process sensory information such as pain 34,37–40,42 . Patients suffering from PD may exhibit impaired BG functioning, and thus, by modulating BG circuitry via DBS, pain processing can be managed.…”

Burst Motor Cortex Stimulation Evokes Sustained Suppression of Thalamic Stroke Pain: A Narrative Review and Single-Case Overview

“…First, clinical uncontrolled case series data have suggested that the application of burst waveforms for MCS along with a tonic MCS pattern is reasonably safe [19]. Currently available neurostimulation devices would facilitate this approach and notably enable assessment of the efficacy of different MCS paradigms in sham-controlled studies, as previously reported for burst SCS targeting drug-resistant chronic pain and movement disorders [30][31][32] (see Table 1).…”

“…BurstDR TM , a relatively novel stimulation waveform, has been approved and is mainly used for spinal cord stimulation treatment of various pain conditions [30][31][32]. Here, we present our long-term comparative findings in a single patient with CPP treated with an MCS approach, assessing the effects of cMCS versus burstMCS waveforms on the neuropathic pain levels observed over a 5-year period.…”