High Cervical Spinal Cord Stimulation: A One Year Follow-Up Study on Motor and Non-Motor Functions in Parkinson's Disease.

Paolo Mazzone,Margherita Giamundo,Stefano Ferraina,Francesco Masedu,Fabio Viselli,Marco Paoloni,Eugenio Scarnati,Annamaria Capozzo,Massimo Marano

doi:10.3390/brainsci9040078

Abstract

Background: The present study investigated the effectiveness of stimulation applied at cervical levels on pain and Parkinson’s disease (PD) symptoms using either tonic or burst stimulation mode. Methods: Tonic high cervical spinal cord stimulation (T-HCSCS) was applied on six PD patients suffering from low back pain and failed back surgery syndrome, while burst HCSCS (B-HCSCS) was applied in twelve PD patients to treat primarily motor deficits. Stimulation was applied percutaneously with quadripolar or octapolar electrodes. Clinical evaluation was assessed by the Unified Parkinson’s Disease Rating Scale (UPDRS) and the Hoehn and Yahr (H&Y) scale. Pain was evaluated by a visual analog scale. Evaluations of gait and of performance in a cognitive motor task were performed in some patients subjected to B-HCSCS. One patient who also suffered from severe autonomic cardiovascular dysfunction was investigated to evaluate the effectiveness of B-HCSCS on autonomic functions. Results: B-HCSCS was more effective and had more consistent effects than T-HCSCS in reducing pain. In addition, B-HCSCS improved UPDRS scores, including motor sub-items and tremor and H&Y score. Motor benefits appeared quickly after the beginning of B-HCSCS, in contrast to long latency improvements induced by T-HCSCS. A slight decrease of effectiveness was observed 12 months after implantation. B-HCSCS also improved gait and ability of patients to correctly perform a cognitive–motor task requiring inhibition of a prepared movement. Finally, B-HCSCS ameliorated autonomic control in the investigated patient. Conclusions: The results support a better usefulness of B-HCSCS compared to T-HCSCS in controlling pain and specific aspects of PD motor and non-motor deficits for at least one year.

Highlights

Spinal cord stimulation (SCS) is a well-established neuromodulatory therapy [1] for the treatment of neuropathic pain
The positive effects that we report by applying stimulation at high cervical levels, i.e., at a level closer to brainstem structures compared to the more distant thoracic levels, suggest that cervical stimulation, in addition to modulating the activity of dorsal column and dorsal horn elements involved in pain control, may act by modulating the activity of motor and vegetative brainstem nuclei
burst High cervical SCS (HCSCS) (B-HCSCS) appears to be more effective than Tonic high cervical spinal cord stimulation (T-HCSCS) in improving pain as well as motor disabilities and tremor in Parkinson’s disease (PD) and atypical parkinsonisms at least after one year of application

Summary

Introduction

Spinal cord stimulation (SCS) is a well-established neuromodulatory therapy [1] for the treatment of neuropathic pain. Most of the above clinical studies have been carried out by stimulating the spinal cord at thoracic levels. The present study investigated the effectiveness of stimulation applied at cervical levels on pain and Parkinson’s disease (PD) symptoms using either tonic or burst stimulation mode. Methods: Tonic high cervical spinal cord stimulation (T-HCSCS) was applied on six PD patients suffering from low back pain and failed back surgery syndrome, while burst HCSCS (B-HCSCS) was applied in twelve PD patients to treat primarily motor deficits. One patient who suffered from severe autonomic cardiovascular dysfunction was investigated to evaluate the effectiveness of

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Results

Discussion

Conclusion