Extradural Motor Cortex Stimulation in Parkinson’s Disease: Long-Term Clinical Outcome
Abstract
:1. Introduction
2. Materials and Methods
2.1. Surgical Technique
2.2. Parameter and Medication Adjustments
2.3. Outcome Measures
2.4. Statistical Analysis
3. Results
3.1. Motor Efficacy
3.2. Disease Severity
3.3. DLA and QoL
3.4. Cognitive and Behvioral Outcome
3.5. Safety
4. Discussion
Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Patient | Gender | Age at Surgery | UPDRS III Off-Med | UPDRS III On-Med | Hoehn and Yahr Stage | UPDRS IV | LEDD (mg) | Reason DBS Not Performed |
---|---|---|---|---|---|---|---|---|
1 | F | 57 | 8 | 55 | 24 | 5 | 13 | Patient refusal |
2 | M | 55 | 16 | 68 | 19 | 5 | 13 | Brain atrophy |
3 | M | 62 | 9 | 62 | 18 | 4 | 11 | Patient refusal |
4 | F | 57 | 14 | 64 | 24 | 5 | 15 | Brain atrophy |
5 | F | 66 | 28 | 61 | 35 | 5 | 12 | Patient refusal |
6 | F | 69 | 17 | 59 | 15 | 5 | 12 | Age and comorbidities |
7 | F | 70 | 14 | 62 | 17 | 5 | 9 | Age and comorbidities |
8 | M | 72 | 11 | 43 | 16 | 3 | 6 | Age and comorbidities |
9 | M | 68 | 14 | 40 | 18 | 3 | 3 | Patient refusal |
Total | 4 M/5 F | 64.0 ± 6.4 | 14.6 ± 5.9 | 57.1 ± 9.5 | 20.7 ± 6.2 | 4.4 ± 0.9 | 10.4 ± 3.8 |
Baseline (n = 9) | 12 m (n = 9) | 18 m (n = 9) | 24 m (n = 9) | 36 m (n = 7) | 48 m (n = 6) | 60 m (n = 5) | 72 m (n = 5) | 84 m (n = 2) | 96 m (n = 2) | |
---|---|---|---|---|---|---|---|---|---|---|
UPDRS III med-off | 57.1 ± 9.5 | 49.2 ± 9.4 * | 47.9 ± 12.4 * | 46.6 ± 11.0 * | 45.1 ± 12.7 * | 52.3 ± 14.0 | 48.2 ± 4.0 * | 52.2 ± 6.2 * | 45.5 ± 13.4 | 49.5 ± 9.2 |
UPDRS III axial score med-off | 13.6 ± 5.6 | 11.9 ± 3.8 | 9.9 ± 3.3 * | 9.7 ± 2.6 * | 10.7 ± 3.5 | 13.5 ± 4.0 | 12.8 ± 3.1 * | 14.4 ± 3.7 | 11.5 ± 4.9 | 14.0 ± 4.2 |
UPDRS III med-on | 20.7 ± 6.2 | 27.1 ± 8.7 | 26.0 ± 6.5 | 26.7 ± 6.2 | 30.0 ± 7.1 * | 34.8 ± 9.9 * | 33.2 ± 5.1 * | 39.2 ± 9.0 * | 37.5 ± 13.4 | 45.0 ± 9.9 |
UPDRS IV | 10.4 ± 3.8 | 7.2 ± 3.6 * | 8.0 ± 4.0 | 8.1 ± 3.0 * | 9.7 ± 3.3 | 10.3 ± 2.7 | 7.8 ± 1.6 * | 6.6 ± 2.3 * | 7.5 ± 2.1 | 7.5 ± 2.1 |
LEDD | 1203.0 ± 528.1 | 1085.8 ± 424.5 | 1108.0 ± 402.3 | 1050.8 ± 369.3 | 962.4 ± 455.6 | 929.9 ± 401.0 | 1061.3 ± 286.5 * | 1214.2 ± 670.8 | 905.0 ± 254.6 | 915.0 ± 268.7 |
UPDRS II | 27.5 ± 10.0 | 22.4 ± 6.9 * | 19.1 ± 6.9 | 24.7 ± 9.0 | 27.5 ± 6.1 | 25.3 ± 8.8 | 22.6 ± 4.0 * | 23.6 ± 3.2 * | 25.0 ± 1.4 | 27.5 ± 2.1 |
PDQL | 83.5 ± 19.1 | 98.5 ± 20.0 * | 96.0 ± 15.0 | 95.4 ± 15.5 | 92.7 ± 15.7 | 91.8 ± 22.1 | 102.2 ± 19.6 * | 99.2 ± 28.3 | 88.0 ± 15.6 | 102.5 ± 44.5 |
UPDRS tot | 98.8 ± 24.5 | 82.3 ± 16.9 * | 79.1 ± 21.5 * | 83.7 ± 22.1 * | 89.3 ± 17.5 | 92.3 ± 23.8 | 82.8 ± 5.5 | 88.0 ± 8.5 | 83.5 ± 10.6 | 90.0 ± 8.5 |
Baseline (n = 9) | 12 m (n = 9) | 18 m (n = 9) | 36 m (n = 7) | 60 m (n = 5) | 96 m (n = 2) | |
---|---|---|---|---|---|---|
MMSE | 25.3 ± 2.6 | 25.9 ± 3.0 | 26.7 ± 3.2 * | 26.5 ± 3.9 | 25.0 ± 4.6 | 25.0 ± 2.8 |
Digit Span forward | 4.6 ± 0.7 | 4.7 ± 1.0 | 4.4 ± 0.5 | 4.0 ± 0.6 | 5.0 ± 0 | 4.5 ± 0.7 |
Digit Span backward | 3.2 ± 0.7 | 3.0 ± 0.7 | 3.0 ± 0.8 | 3.3 ± 0.8 | 3.0 ± 0 | 3.5 ± 0.7 |
Corsi’s Span forward | 4.8 ± 1.3 | 4.6 ± 1.2 | 4.4 ± 1.5 | 4.2 ± 1.2 | 4.0 ± 0 | 3.5 ± 0.7 |
Corsi’s Span backward | 3.8 ± 1.0 | 3.4 ± 1.2 | 3.1 ± 0.9 | 4.2 ± 1.5 | 3.7 ± 0.6 | 3.0 ± 0 |
RAVLT immediate recall | 35.3 ± 6.8 | 42.2 ± 12.2 | 45.9 ± 10.9 * | 32.7 ± 5.7 | 43.7 ± 7.0 | 23.5 ± 2.1 |
RAVLT delayed recall | 7.0 ± 2.2 | 8.5 ± 3.7 | 9.7 ± 3.0 * | 6.2 ± 1.2 | 10.0 ± 4.4 | 4.0 ± 0 |
RPM ’47 | 20.0 ± 7.3 | 21.5 ± 2.7 | 21.4 ± 6.9 | 22.7 ± 8.6 | 24.0 ± 9.2 | 19.5 ± 4.9 |
Phonological verbal fluency | 17.3 ± 8.3 | 19.5 ± 11.9 | 23.0 ± 13.6 | 19.2 ± 11.0 | 20.7 ± 9.3 | 21.0 ± 15.6 |
Semantic verbal fluency | 14.1 ± 4.0 | 12.7 ± 4.1 | 13.9 ± 3.4 | 14.0 ± 5.1 | 16.3 ± 6.8 | 15.0 ± 8.5 |
mWCST criteria | 2.4 ± 1.6 | 2.6 ± 1.7 | 3.7 ± 2.1 | 2.8 ± 1.6 | 2.3 ± 2.3 | 1.5 ± 0.7 |
mWCST total errors | 23.4 ± 10.4 | 20.5 ± 8.7 | 17.1 ± 11.6 | 19.8 ± 8.3 | 24.0 ± 17.6 | 21.0 ± 1.4 |
mWCST perseverative errors | 8.1 ± 4.9 | 8.5 ± 5.6 | 7.0 ± 5.4 | 6.5 ± 3.3 | 6.6 ± 7.0 | 6.5 ± 3.5 |
Stroop interference time | 33.7 ± 32.2 | 35.2 ± 17.8 | 35.0 ± 25.1 | 25.7 ± 14.0 | 48.3 ±55.2 | 37.5 ±10.6 |
Stroop interference errors | 1.5 ± 3.9 | 2.2 ± 3.6 | 3.1 ± 4.8 | 2.3 ± 2.1 | 3.0 ± 3.3 | 6.0 ± 8.5 |
Zung Depression Scale | 45.6 ± 13.6 | 46.4 ± 12.5 | 44.6 ± 8.1 | 47.3 ± 8.8 | 47.6 ± 9.3 | 55.0 ± 1.4 |
Zung Anxiety Scale | 44.9 ± 12.9 | 47.5 ± 10.0 | 44.4 ± 8.0 | 46.8 ± 8.5 | 43.0 ± 11.5 | 44.0 ± 0 |
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Piano, C.; Bove, F.; Mulas, D.; Di Stasio, E.; Fasano, A.; Bentivoglio, A.R.; Daniele, A.; Cioni, B.; Calabresi, P.; Tufo, T. Extradural Motor Cortex Stimulation in Parkinson’s Disease: Long-Term Clinical Outcome. Brain Sci. 2021, 11, 416. https://doi.org/10.3390/brainsci11040416
Piano C, Bove F, Mulas D, Di Stasio E, Fasano A, Bentivoglio AR, Daniele A, Cioni B, Calabresi P, Tufo T. Extradural Motor Cortex Stimulation in Parkinson’s Disease: Long-Term Clinical Outcome. Brain Sciences. 2021; 11(4):416. https://doi.org/10.3390/brainsci11040416
Chicago/Turabian StylePiano, Carla, Francesco Bove, Delia Mulas, Enrico Di Stasio, Alfonso Fasano, Anna Rita Bentivoglio, Antonio Daniele, Beatrice Cioni, Paolo Calabresi, and Tommaso Tufo. 2021. "Extradural Motor Cortex Stimulation in Parkinson’s Disease: Long-Term Clinical Outcome" Brain Sciences 11, no. 4: 416. https://doi.org/10.3390/brainsci11040416
APA StylePiano, C., Bove, F., Mulas, D., Di Stasio, E., Fasano, A., Bentivoglio, A. R., Daniele, A., Cioni, B., Calabresi, P., & Tufo, T. (2021). Extradural Motor Cortex Stimulation in Parkinson’s Disease: Long-Term Clinical Outcome. Brain Sciences, 11(4), 416. https://doi.org/10.3390/brainsci11040416