gms | German Medical Science

59th Annual Meeting of the German Society of Neurosurgery (DGNC)
3rd Joint Meeting with the Italian Neurosurgical Society (SINch)

German Society of Neurosurgery (DGNC)

1 - 4 June 2008, Würzburg

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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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  • corresponding author A. Lavano - Neurosurgical Department, University of Catanzaro, Italy
  • B. Cioni - Neurosurgical Department, University of Catanzaro, Italy
  • A. Dario - Neurosurgical Department, University of Catanzaro, Italy
  • A. Landi - Neurosurgical Department, University of Catanzaro, Italy
  • S. Zeme - Neurosurgical Department, University of Catanzaro, Italy
  • C. Sturiale - Neurosurgical Department, University of Catanzaro, Italy
  • P. Romanelli - Neurosurgical Department, University of Catanzaro, Italy
  • M. De Rose - Neurosurgical Department, University of Catanzaro, Italy

Deutsche Gesellschaft für Neurochirurgie. Società Italiana di Neurochirurgia. 59. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3. Joint Meeting mit der Italienischen Gesellschaft für Neurochirurgie (SINch). Würzburg, 01.-04.06.2008. Düsseldorf: German Medical Science GMS Publishing House; 2008. DocMO.04.08

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2008/08dgnc064.shtml

Published: May 30, 2008

© 2008 Lavano et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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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.