Motor cortex stimulation in patients with Parkinson disease: 12-month follow-up in 4 patients

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Object

Since the initial 1991 report by Tsubokawa et al., stimulation of the M1 region of cortex has been used to treat chronic pain conditions and a variety of movement disorders.

Methods

A Medline search of the literature published between 1991 and the beginning of 2007 revealed 459 cases in which motor cortex stimulation (MCS) was used. Of these, 72 were related to a movement disorder. More recently, up to 16 patients specifically with Parkinson disease were treated with MCS, and a variety of results were reported. In this report the authors describe 4 patients who were treated with extradural MCS.

Results

Although there were benefits seen within the first 6 months in Unified Parkinson's Disease Rating Scale Part III scores (decreased by 60%), tremor was only modestly managed with MCS in this group, and most benefits seen initially were lost by the end of 12 months.

Conclusions

Although there have been some positive findings using MCS for Parkinson disease, a larger study may be needed to better determine if it should be pursued as an alternative surgical treatment to DBS.

Abbreviations used in this paper: DBS = deep brain stimulation; MCS = motor cortex stimulation; PD = Parkinson disease; SSEP = somatosensory evoked potential; UPDRS = Unified Parkinson's Disease Rating Scale.

Article Information

Address correspondence to: Jeffrey Arle, M.D., Ph.D., Department of Neurosurgery, Lahey Clinic, Burlington, Massachusetts 01805. email: jeffrey.arle@lahey.org.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Tracing, image of brain, and intraoperative photograph. Determination of the M1 region intraoperatively involves using the 4-contact lead itself in finding the reversal potential of the N20 signal. By placing the lead perpendicular to the suspected region and moving it slightly each test, an extradural map could be made.

  • View in gallery

    Intraoperative photograph and tracings providing further clarification of the M1 region, particularly in delineating face from arm and hand by testing with the ball-probe stimulus. The signal was measured by performing electromyography of specific muscle groups distally, verifying the subregions of the motor cortex. APB = abductor pollicis brevis; FDI = first dorsal interosseous.

  • View in gallery

    Bar graph showing UPDRS Part III scores over time in all 4 patients who underwent MCS. The mean values are superimposed. Note that there appears to be initial improvement within the first 6 months of surgery. However, a trend toward returning to baseline preoperative values is suggested by 12 months after surgery.

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