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

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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.


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.


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.


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:

© AANS, except where prohibited by US copyright law.



  • 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.


  • 1

    Alterman RLSterio DBeric AKelly PJ: Microelectrode recording during posteroventral pallidotomy: impact on target selection and complication. Neurosurgery 44:3153231999

  • 2

    Amassian VEStewart MQuirk GJRosenthal JL: Physiological basis of motor effects of a transient stimulus to cerebral cortex. Neurosurgery 20:74931987

  • 3

    Arle JEShils JL: Motor cortex simulation for pain and movement disorders. Neurotherapeutics 5:37492008

  • 4

    Brown JALutsep HCramer SCWeinand M: Motor cortex stimulation for enhancement of recovery after stroke: case report. Neurol Res 25:8158182003

  • 5

    Brown JALutsep HLWeinand MCramer SC: Motor cortex stimulation for the enhancement of recovery from stroke: a prospective, multicenter safety study. Neurosurgery 58:4644732006

  • 6

    Canavero SBonicalzi V: Therapeutic extradural cortical stimulation for central and neuropathic pain: a review. Clin J Pain 18:48552002

  • 7

    Canavero SBonicalzi VCastellano GPerozzo PMassa-Micon B: Painful supernumerary phantom arm following motor cortex stimulation for central post stroke pain. J Neurosurg 91:1211221999

  • 8

    Canavero SBonicalzi VPaolotti RCastellano GGreco-Crasto SRizzo L: Therapeutic extradural cortical stimulation for movement disorders: a review. Neurol Res 25:1181222003

  • 9

    Canavero SPaolotti RBonicalzi VCastellano GGreco-Crasto SRizzo L: Extradural motor cortex stimulation for advanced Parkinson disease. J Neurosurg 97:120812112002

  • 10

    Carroll DJoint CMaartens NShlugman DStein JAziz TZ: Motor cortex stimulation for chronic neuropathic pain: a preliminary study of 10 cases. Pain 84:4314372000

  • 11

    Drouot XOshino SJarraya BBesret LKishima HRemy P: Functional recovery in a primate model of Parkinson's disease following motor cortex stimulation. Neuron 44:7697782004

  • 12

    Ebel HRust DTronnier VBoker DKunze S: Chronic precentral stimulation in trigeminal neuropathic pain. Acta Neurochir (Wien) 138:130013061996

  • 13

    Franzini AFerroli PDones IMarras CBroggi G: Chronic motor cortex stimulation for movement disorders: a promising perspective. Neurol Res 25:1231262003

  • 14

    Franzini AFerroli PServello DBroggi G: Reversal of thalamic hand syndrome by long-term motor cortex stimulation. J Neurosurg 93:8738752000

  • 15

    Fujii MOhmoto YKitahara TSugiyama SUesugi SYamashita T: [Motor cortex stimulation therapy in patients with thalamic pain.]. No Shinkei Geka 25:3153191997

  • 16

    Garcia-Larrea LPeyron RMertens PGregoire MCLavenne FLe Bars D: Electrical stimulation of motor cortex for pain control: a combined PET-scan and electrophysiological study. Pain 83:2592731999

  • 17

    Hanajima RAshby PLang AELozano AM: Effects of acute stimulation through contacts placed on the motor cortex for chronic stimulation. Clin Neurophysiol 113:6356412002

  • 18

    Heath RG: Psychiatry. Annu Rev Med 5:2232361954

  • 19

    Herregodts PStadnik TDe Ridder FD'Haens J: Cortical stimulation for central neuropathic pain: 3-D surface MRI for easy determination of the motor cortex. Acta Neurochir Suppl 641321351995

  • 20

    Hosobuchi YMotor cortex stimulation for control of central deaf-ferentation pain. Devinsky OBeric ADogari M: Electrical and Magnetic Stimulation of the Brain and Spinal Cord New YorkRaven Press1993. 215217

  • 21

    Katayama YFukaya CYamamoto T: Control of post-stroke involuntary and voluntary movement disorders with deep brain or epidural cortical stimulation. Stereotact Funct Neurosurg 69:73791997

  • 22

    Katayama YFukaya CYamamoto T: Poststroke pain control by chronic motor cortex stimulation neurological characteristics predicting a favorable response. J Neurosurg 89:5855911998

  • 23

    Katayama YOshima HFukaya CKawamata TYamamaoto T: Control of post-stroke movement disorders using chronic motor cortex stimulation. Acta Neurochir Suppl 7989922001

  • 24

    Katayama YTsubokawa TYamamoto T: Chronic motor cortex stimulation for central deafferentation pain: experience with bulbar pain secondary to Wallenberg syndrome. Stereotact Funct Neurosurg 62:2952991994

  • 25

    Katayama YYamamoto TKobayashi KKasai MOshima HFukaya C: Motor cortex stimulation for phantom limb pain: comprehensive therapy with spinal cord and thalamic stimulation. Stereotact Funct Neurosurg 77:1591612001

  • 26

    Kleiner-Fisman GFisman DNKahn FISime ELozano AMLang AE: Motor cortical stimulation for parkinsonism in multiple system atrophy. Arch Neurol 60:155415582003

  • 27

    Manola LHolsheimer JVeltink PBuitenweg JR: Anodal vs cathodal stimulation of motor cortex: a modeling study. Clin Neurophysiol 118:4644742007

  • 28

    Mertens PNuti CSindou MGuenot MPeyron RGarcia-Larrea L: Precentral cortex stimulation for the treatment of central neuropathic pain: results of a prospective study in a 20-patient series. Stereotact Funct Neurosurg 73:1221251999

  • 29

    Meyerson BALindblom ULinderoth BLind GHerregodts P: Motor cortex stimulation as treatment of trigeminal neuropathic pain. Acta Neurochir Suppl (Wien) 58:1501531993

  • 30

    Migita KUozumi TArita KMonden S: Transcranial magnetic coil stimulation in patients with central pain. Technique and application. Neurosurgery 36:103710401995

  • 31

    Mogilner AYRezai AR: Epidural motor cortex stimulation with functional imaging guidance. Neurosurg Focus 11:3E42001

  • 32

    Nguyen JPLefaucheur JPDecq PUchiyama TCarpentier AFontaine D: Chronic motor cortex stimulation in the treatment of central and neuropathic pain. Correlations between clinical, electrophysiological and anatomical data. Pain 82:2452511999

  • 33

    Nguyen JPPollin BFeve AGeny CCesaro P: Improvement of action tremor by chronic cortical stimulation. Mov Disord 13:84881998

  • 34

    Pagni CAAltibrandi MGBentivoglio ACaruso GCioni BFiorella C: Extradural motor cortex stimulation (EMCS) for Parkinson's disease. History and first results by the study group of the Italian neurosurgical society. Acta Neurochir Suppl 931131192005

  • 35

    Pagni CAZeme SZenga F: Further experience with extradural motor cortex stimulation for treatment of advanced Parkinson's disease. Report of 3 new cases. J Neurosurg Sci 47:1891932003

  • 36

    Pagni CAZeme SZenga FMaina R: Extradural motor cortex stimulation in advanced Parkinson's disease: the Turin experience: technical case report. Neurosurgery 57:4 SupplE4022005

  • 37

    Peyron RGarcia-Larrea LDeiber MPCinotti LConvers PSindou M: Electrical stimulation of precentral cortical area in the treatment of central pain: electrophysiological and PET study. Pain 62:2752861995

  • 38

    Pirotte BVoordecker PJoffroy FMassager NWikler DBaleriaux D: The Zeiss-MKM system for frameless image-guided approach in epidural motor cortex stimulation for central neuropathic pain. Neurosurg Focus 11:3E32001

  • 39

    Rainov NGFels CHeidecke VBurkert W: Epidural electrical stimulation of the motor cortex in patients with facial neuralgia. Clin Neurol Neurosurg 99:2052091997

  • 40

    Rainov NGHeidecke V: Motor cortex stimulation for neuropathic facial pain. Neurol Res 25:1571612003

  • 41

    Rasche DRuppolt MStippich CUnterberg ATronnier VM: Motor cortex stimulation for long-term relief of chronic neuropathic pain: a 10 year experience. Pain 121:43522006

  • 42

    Rodríguez RFContreras N: Bilateral motor cortex stimulation for the relief of central dysesthetic pain and intentional tremor secondary to spinal cord surgery: a case report. Neuromodulation 5:1891952002

  • 43

    Roux FEIbarrola DTremoulet MLazorthes YHenry PSol JC: Methodological and technical issues for integrating functional Magnetic Resonance Imaging data in a neuronavigation system. Neurosurgery 49:114511572001

  • 44

    Saitoh YHirano SKato AKishima HHirata MYamamoto K: Motor cortex stimulation for deafferentation pain. Neurosurg Focus 11:3E12001

  • 45

    Saitoh YKato ANinomiya HBaba TShibata MMashimo T: Primary motor cortex stimulation within the central sulcus for treating deafferentation pain. Acta Neurochir Suppl 871491522003

  • 46

    Saitoh YShibata MHirano SHirata MMashimo TYoshimine T: Motor cortex stimulation for central and peripheral deafferentation pain. Report of 8 cases. J Neurosurg 92:1501552000

  • 47

    Saitoh YShibata MSanada YMahimo T: Motor cortex stimulation for phantom limb pain. Lancet 353:2121999

  • 48

    Smith HJoint CSchlugman DNandi DStein JFAziz TZ: Motor cortex stimulation for neuropathic pain. Neurosurg Focus 11:3E22001

  • 49

    Sol JCCasaux JRoux FELotterie JABousquet PVerdie JC: Chronic motor cortex stimulation for phantom limb pain: correlations between pain relief and functional imaging studies. Stereotact Funct Neurosurg 77:1721762001

  • 50

    Son UCKim MCMoon DEKang JK: Motor cortex stimulation in a patient with intractable complex regional pain syndrome Type II with hemibody involvement. J Neurosurg 98:1751792003

  • 51

    Terao TTakahashi HYokochi FTaniguchi MOkiyama RHamada I: Hemorrhagic complication of stereotactic surgery in patients with movement disorders. J Neurosurg 98:124112462003

  • 52

    Tsubokawa TKatayama YYamamoto THirayama TKoyama S: Chronic motor cortex stimulation for the treatment of central pain. Acta Neurochir Suppl (Wien) 52:1371391991

  • 53

    Tsubokawa TKatayama YYamamoto THirayama TKoyama S: Chronic motor cortex stimulation in patients with thalamic pain. J Neurosurg 78:3934011993

  • 54

    Velasco MVelasco FBrito FVelasco ALNguyen JPMarquez I: Motor cortex stimulation in the treatment of deafferentation, pain. I. Localization of the motor cortex. Stereotact Funct Neurosurg 79:1461672002

  • 55

    Voges JWaerzeggers YMaarouf MLehrke RKoulousakis ALenartz D: Deep-brain stimulation: long-term analysis of complications caused by hardware and surgery—experiences from a single centre. J Neurol Neurosurg Psychiatry 77:8688722006

  • 56

    Woolsey CNErickson TCGilson WE: Localization in somatic sensory and motor areas of human cerebral cortex as determined by direct recording of evoked potentials and electrical stimulation. Neurosurgery 51:4765061979


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