Spinal Cord Stimulation for the Treatment of Abnormal Posture and Gait Disorder in Patients With Parkinson's Disease

Abstract

Patients with advanced Parkinson's disease (PD) often present with axial symptoms, including abnormal posture, postural instability, and gait disorder. Although spinal cord stimulation (SCS) is effective for pain, little is known about the effect of SCS on motor function in PD patients. The present study investigated the effect of SCS on posture and gait in 15 PD patients, 5 men and 10 women aged 63-79 years (mean 71.1 years), with low back pain and leg pain who received SCS. A visual analog scale (VAS) was used for pain evaluation pre-and postoperatively. The Unified Parkinson's Disease Rating Scale, Timed Up and Go tests, and Timed 10-Meter Walk tests were used to evaluate motor function and activities of daily living of patients. Preoperative mean VAS score was 8.9 (range 7.8-10), which showed significant postoperative improvement at 3 months to mean VAS score of 2.0 (range 0-3.3). The improvements in VAS scores persisted at 12 months after surgery with mean VAS score of 2.3 (range 0-4). Posture and postural stability motor subscores were improved at 3 months after SCS, and gait had significantly improved at 3 months and 1 year after surgery. Timed 10-Meter Walk tests also demonstrated that patient gait was significantly improved at 3 months and 12 months after surgery. Most advanced stage PD patients suffer considerable pain that causes abnormal posture and gait disturbance. SCS is expected to lead to both amelioration of pain and improvement of motor function in such patients.

Spinal Stimulation for Movement Disorders

“…Although the patient reported by our group was> 70 years of age, he had an excellent response to levodopa with limited axial motor impairment. Similarly, in the study by Agari and Date [16] the patients displayed limited axial symptoms without any major gait abnormalities. Patients in the 2 other reports [18,19] were younger (43 and 68 years old, respectively), but their clinical characteristics were less precisely described.…”

“…Additionally, a 43-year-old woman with PD who benefited from stimulation at the C2 level for neck and upper extremity neurogenic pain displayed a 40 % improvement in the motor UPDRS-III score following SCS [15]. A larger Japanese study of 15 patients with PD suffering from neuropathic pain and treated with thoracic SCS using percutaneous leads showed some improvement in PD symptoms [16]. Because pain localization [12], which concluded a lack of clinical benefit, the 2 patients were>70 years old, had advanced disease with poor levodopa responsiveness, and 1 had severe gait abnormalities.…”

“…The technique consists of inserting an epidural lead containing multiple stimulating electrodes (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16). The leads can be percutaneous or surgical paddle leads.…”

“…Subsequent open-label clinical trials using SCS have emerged in different types of movement disorders, as illustrated by the publication of large series of patients, up to 1336, operated between 1972 and 1997 [9]. More recently, promising studies in animal models of Parkinson's disease (PD) brought SCS up to date in movement disorders [10,11], followed quickly by case reports in patients suffering from PD [12][13][14][15][16][17].…”

Mechanisms underlying cortical resonant states: implications for levodopa-induced dyskinesia

“…In PD, a similar approach using spinal cord stimulation (SCS) has been tested for the purpose of interfering with synchronized low-frequency oscillations characteristic of the parkinsonian state. Good results were initially achieved in rodent models of PD (Fuentes et al, 2009), and more recently, clinically validated effects have also been reported ( Agari and Date, 2012;F é nelon et al, 2012;Hassan et al, 2013; see also Nicolelis et al, 2010). In the treatment of levodopa-induced dyskinesia, however, stimulation of afferent pathways remains to be evaluated.…”