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

Jeffrey E. ArleDepartments of Neurosurgery and Neurology, Lahey Clinic, Burlington;

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 M.D., Ph.D.
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Diana ApetauerovaDepartments of Neurosurgery and Neurology, Lahey Clinic, Burlington;

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 M.D.
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Janet ZaniDepartments of Neurosurgery and Neurology, Lahey Clinic, Burlington;

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D. Vedran DeletisDepartment of Neurosurgery, St. Lukes-Roosevelt Hospital, New York, New York

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Dana L. PenneyDepartments of Neurosurgery and Neurology, Lahey Clinic, Burlington;

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Daniel HoitDepartment of Neurosurgery, Tufts University School of Medicine, Boston, Massachusetts; and

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 M.D., M.P.H.
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Christine GouldDepartments of Neurosurgery and Neurology, Lahey Clinic, Burlington;

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Jay L. ShilsDepartments of Neurosurgery and Neurology, Lahey Clinic, Burlington;

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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.
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