Spinal cord stimulation in Parkinson’s disease: a review of the preclinical and clinical data and future prospects

Cai, Yi; Reddy, Rajiv; Varshney, Vishal; Chakravarthy, Krishnan

doi:10.1186/s42234-020-00041-9

Cited by 27 publications

(21 citation statements)

References 39 publications

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“…Delayed bolus transport to pharynx with altered pharyngeal peristaltic movement may be excitatory-inhibitory reflex rhythm modification 38 as early marker in PD 40,41 . These brainstem reflex rhythms might improve with cervical electric stimulation therapies 42 .…”

Section: Discussionmentioning

confidence: 99%

Subtle oromotor signs in early Parkinson’s disease before clinical manifestations of dysphagia

Gudwani

Upadhyay

Sharma

et al. 2021

Preprint

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Background: Swallowing is complex phenomena comprising oral (preparatory and pre-swallow positioning), oropharyngeal, pharyngeal and esophageal phases. The timing of these phases is controlled by brain stem pattern generators including reflex for oropharyngeal propulsion and transit. Dysphagia in Parkinson's disease (PD) commonly observed at late stages with aspiration, pneumonia and hospitalization. Objective: Can subtle oromotor signs (if any) be observed for planning early interventions in PD Methods: The present study investigated oromotor function in fourteen early PD (onset ≤2years; H&Y ≤2.5) with dynamic MRI using saline (water) bolus and compared with seven age-matched healthy controls. Results: All the patients with PD were non-symptomatic for dysphagia by self-reporting, and on clinical assessment (Part-II MDS-UPDRS, Swallowing disturbance questionnaire, SDQ and Clinical assessment of dysphagia in neurodegeneration, CADN). Qualitatively MR images visualized, differences in PD compared to healthy controls for tongue-wave, velar-closure or release, bolus placement, oropharyngeal reflex-initiation, transit-time, epiglottic-closure-coordination and post-swallow oral or pharyngeal residue. Descriptive analysis showed higher variability of velar-closure, oropharyngeal- and pharygoesophageal-transit time in patient with PD. Group analysis (two-sample) show significant difference for velar-closure. Conclusion: Multiple lingual-waves, reverse-tongue thrust, with delayed velar control attributed to incoordinated muscular rhythm. Variable oropharyngeal transit time (0.64 to 2.25 msec) in PD ascribed to brainstem degenerative changes. Findings imply that subtle observable early oromotor signs as pre-clinical manifestation when evaluated with non-invasive, non-contrast dynamic MRI support early intervention, to prevent late-stage aspiration episodes and consequent hospitalizations.

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Section: Discussionmentioning

confidence: 99%

Subtle oromotor signs in early Parkinson’s disease before clinical manifestations of dysphagia

Gudwani

Upadhyay

Sharma

et al. 2021

Preprint

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“…Then, 3 brief reports of SCS were published, with no extensive descriptions (Soltani and Lalkhen, 39 Mitsuyama et al, 40 and Nishioka and Nakajima 41 ), showing benefits, despite some conflicting results. For a more detailed review of these studies, see Cai et al 43 Table 1 summarizes these findings.…”

Section: Spinal Cord Stimulation and Pdmentioning

confidence: 99%

History of and Insights Into Spinal Cord Stimulation in Parkinson Disease

Garcia¹,

Ricardo²,

Araújo

et al. 2020

Neurorehabil Neural Repair

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Background Current available therapies for Parkinson disease (PD) have strong limitations, and patients usually present with refractory symptoms despite all efforts. Deep brain stimulation (DBS), which has been used in PD patients for decades (since 1987), has best indications for symptoms like tremor, motor fluctuations, or dyskinesia. However, postural instability and gait disturbances (PIGD) have restricted benefits with DBS. In 2009, spinal cord stimulation (SCS), a well-established therapy for chronic pain, has emerged as a potential alternative therapy that may help control unresponsive symptoms such as bradykinesia, PIGD, and freezing of gait. Methods The main studies regarding SCS in PD are reviewed here from the first studies in animal models to the latest clinical trials. Conclusions Despite promising findings, the heterogeneity of methodologies used and small samples in human studies pose a challenging problem to be addressed in order to have robust clinical evidence to support SCS as a viable PD treatment

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“…Thereafter, the same group reported that improvement in FoG‐Q scores, FoG episodes, and duration of FoG episodes was sustained in those patients three‐years post‐SCS surgery (97). Additional studies have explored prospective thoracic SCS with moderate benefits (135–137).…”

Section: Targets Of Neuromodulationmentioning

confidence: 99%

Freezing of Gait in Parkinson’s Disease: Invasive and Noninvasive Neuromodulation

Rahimpour

Gaztanaga

Yadav

et al. 2021

Neuromodulation: Technology at the Neural Interface

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Introduction: Freezing of gait (FoG) is one of the most disabling yet poorly understood symptoms of Parkinson's disease (PD). FoG is an episodic gait pattern characterized by the inability to step that occurs on initiation or turning while walking, particularly with perception of tight surroundings. This phenomenon impairs balance, increases falls, and reduces the quality of life.Materials and Methods: Clinical-anatomical correlations, electrophysiology, and functional imaging have generated several mechanistic hypotheses, ranging from the most distal (abnormal central pattern generators of the spinal cord) to the most proximal (frontal executive dysfunction). Here, we review the neuroanatomy and pathophysiology of gait initiation in the context of FoG, and we discuss targets of central nervous system neuromodulation and their outcomes so far. The PubMed database was searched using these key words: neuromodulation, freezing of gait, Parkinson's disease, and gait disorders. Conclusion:Despite these investigations, the pathogenesis of this process remains poorly understood. The evidence presented in this review suggests FoG to be a heterogenous phenomenon without a single unifying pathologic target. Future studies rigorously assessing targets as well as multimodal approaches will be essential to define the next generation of therapeutic treatments.

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Spinal cord stimulation in Parkinson’s disease: a review of the preclinical and clinical data and future prospects

Cited by 27 publications

References 39 publications

Subtle oromotor signs in early Parkinson’s disease before clinical manifestations of dysphagia

Subtle oromotor signs in early Parkinson’s disease before clinical manifestations of dysphagia

History of and Insights Into Spinal Cord Stimulation in Parkinson Disease

Freezing of Gait in Parkinson’s Disease: Invasive and Noninvasive Neuromodulation

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