Article
Efficacy of extradural motor cortex stimulation in advanced idiopathic Parkinson's disease: The experience of the functional neurosurgery study group of the Italian Neurosurgical Society
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Published: | May 30, 2008 |
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Objective: Extradural Motor Cortex Stimulation was recently attempted to treat different movement disorders: we report the results obtained by the Italian Functional Neurosurgery Study Group on Parkinson's disease.
Methods: 41 patients with advanced idiopathic PD were enrolled: they were not eligible for or refused DBS. All patients had long history of disease (5-22 years, mean 13.95±4.97 yrs). They scored III to V on Hoehn-Yahr scale. The score of the UPDRS off-medication was 49-120 (mean 91.173±22.189). Quadripolar plate electrode was introduced in extradural space over hand motor area of one hemisphere usually contralateral to the worst clinical side. 8 cases were implanted bilaterally: only results of the unilateral stimulation will be reported. Clinical assessment was performed by UPDRS at 1, 3, 6, 12 months and at least every 6 months in various conditions: a. before implantation: baseline evaluation off-medication/off-stimulation, b. during treatment:on-medication/on-stimulation and off-medication/on-stimulation. The follow-up varied from 6 months to 3 years.
Results: Stimulation induced significant improvement in total UPDRS score (p<0.050 Wilcoxon-test) and in UPDRS III score (up to 23.12%, p<0.02) in off-medication condition; improvement was mostly observed in ADL, posture, gait, balance, bradykinesia, speech and facial expression (UPDRS III, items 27-28-29-30-31). Clinical benefits were more evident in most affected patients. In addition,according to UPDRS IV data, there was marked attenuation of L-Dopa-induced dyskinesias persisting throughout one year follow-up. Antiparkinsonian drugs intake showed a trend to reduction although not statistically significant.
Conclusions: Unilateral EMCS relieves mostly above axial symptoms, ADL and L-dopa induced dyskinesias. Italian clinical experience adds favorable data to enlarge the series of Parkinsonian patients treated by EMCS.