Spinal cord stimulation for Parkinson’s disease: a systematic review

Abstract

Axial symptoms are a late-developing phenomenon in the course of Parkinson's disease (PD) and represent a therapeutic challenge given their poor response to levodopa therapy and deep brain stimulation. Spinal cord stimulation (SCS) may be a new therapeutic approach for the alleviation of levodopa-resistant motor symptoms of PD. Our purpose was to systematically review the effectiveness of SCS for the treatment of motor symptoms of PD and to evaluate the technical and pathophysiological mechanisms that may influence the outcome efficacy of SCS. A comprehensive literature search was conducted using electronic databases for the period from January 1966 through April 2014. The methodology utilized in this work follows a review process derived from evidence-based systematic review and meta-analysis of randomized trials described in the PRISMA statement. Reports examining SCS for the treatment of PD are limited. Eight studies with a total of 24 patients were included in this review. The overall motor score of the Unified Parkinson's Disease Rating Scale in the on/off-stimulation condition remained unchanged in 6 patients and improved in 18 patients after SCS. SCS appears to yield positive results for PD symptoms, especially for impairments in gait function and postural stability. However, evidence is limited and long-term prospective studies will be required to identify the optimal candidates for SCS and the best parameters of stimulation and to fully characterize the effects of stimulation on motor and nonmotor symptoms of PD.

Spinal Cord Stimulation Therapy for Gait Dysfunction in Advanced Parkinson's Disease Patients

“…Observing reduced asymmetry and variability in gait suggests SCS plays a similar role to levodopa medication by improving bilateral gait coordination, although the precise mechanism of SCS remains unclear. Previous nonhuman primate PD model and rodent PD model studies have proposed that SCS may suppress the aberrant beta‐frequency synchronous corticostriatal oscillations, thereby restoring neural activity in the primary cortex and dorsolateral striatum to a state observed prior to spontaneous locomotion …”

“…Eleven frequency (30, 60, and 130 Hz) and pulse width (200, 300, 400, and 500 microseconds) SCS combinations (the device did not allow program 500 μs/130 Hz to be programmable) at a suprathreshold intensity were single‐blinded to the participant and randomly selected using a randomization table. SCS settings selected were based on previously published studies involving PD gait therapy using SCS . Postoperative study visits lasted approximately 4‐5 hours and were conducted in weeks 2, 4, 6, 8, 10, 12, and 16 (1‐4 months), whereas participants were on‐medications (dopaminergic; +LD/+SCS).…”

“…Progress in the therapeutic use of dorsal spinal cord stimulation (SCS) has produced significant motor and gait improvements in 5 nonhuman primate models of PD and in 24 human PD case studies, although many cases included patients with chronic pain, which limits the significance of reported gait improvements . High‐frequency SCS in 4 PD patients previously treated with STN‐DBS was well tolerated and significantly improved gait .…”

Effectiveness of spinal cord stimulation for painful camptocormia with Pisa syndrome in Parkinson’s disease: a case report

“…Given that drug resistance commonly occurs, SCS has been investigated, which relieves pain by electrically stimulating the posterior funiculus. SCS was recently shown to be particularly effective in patients with Parkinson's disease-unrelated pain and/or postural abnormalities [3][4][5]. In the present case, SCS therapy was effective for a patient with Parkinson's disease who had camptocormia accompanied by intractable chronic pain in the absence of bone lesions and who had no history of botulinum toxin injection, showed resistance to oral carbidopa/levodopa and dopamine agonists, and had previously experienced transient alleviation of symptoms by DBS.…”

“…An alternative treatment strategy is spinal cord stimulation (SCS), which was recently reported to be effective for truncal postural abnormalities, chronic pain, and motor symptoms of Parkinson's disease, though the mechanism of SCS remains unclear [3][4][5].…”