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High Cervical Spinal Cord Stimulation: A One Year Follow-Up Study on Motor and Non-Motor Functions in Parkinson’s Disease

1
Functional Neurosurgery and DBS, Centro Chirurgico Toscano, 52100 Arezzo, Italy
2
Department of Neurology, St John the Baptist Hospital, ACISMOM, 00148 Rome, Italy
3
Department of Physiology and Pharmacology “Vittorio Erspamer” University of Rome La Sapienza, 00185 Rome, Italy
4
Unit of Neurology, Neurophysiology and Neurobiology, Department of Medicine, Campus Bio-Medico University, 00128 Rome, Italy
5
Department of Physical Medicine and Rehabilitation, University of Rome La Sapienza, 00185 Rome, Italy
6
Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L’Aquila, 67100 L’Aquila, Italy
*
Author to whom correspondence should be addressed.
Brain Sci. 2019, 9(4), 78; https://doi.org/10.3390/brainsci9040078
Received: 18 February 2019 / Revised: 20 March 2019 / Accepted: 2 April 2019 / Published: 3 April 2019
(This article belongs to the Section Systems Neuroscience)
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PDF [2446 KB, uploaded 3 April 2019]
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Abstract

Background: The present study investigated the effectiveness of stimulation applied at cervical levels on pain and Parkinson’s disease (PD) symptoms using either tonic or burst stimulation mode. Methods: Tonic high cervical spinal cord stimulation (T-HCSCS) was applied on six PD patients suffering from low back pain and failed back surgery syndrome, while burst HCSCS (B-HCSCS) was applied in twelve PD patients to treat primarily motor deficits. Stimulation was applied percutaneously with quadripolar or octapolar electrodes. Clinical evaluation was assessed by the Unified Parkinson’s Disease Rating Scale (UPDRS) and the Hoehn and Yahr (H&Y) scale. Pain was evaluated by a visual analog scale. Evaluations of gait and of performance in a cognitive motor task were performed in some patients subjected to B-HCSCS. One patient who also suffered from severe autonomic cardiovascular dysfunction was investigated to evaluate the effectiveness of B-HCSCS on autonomic functions. Results: B-HCSCS was more effective and had more consistent effects than T-HCSCS in reducing pain. In addition, B-HCSCS improved UPDRS scores, including motor sub-items and tremor and H&Y score. Motor benefits appeared quickly after the beginning of B-HCSCS, in contrast to long latency improvements induced by T-HCSCS. A slight decrease of effectiveness was observed 12 months after implantation. B-HCSCS also improved gait and ability of patients to correctly perform a cognitive–motor task requiring inhibition of a prepared movement. Finally, B-HCSCS ameliorated autonomic control in the investigated patient. Conclusions: The results support a better usefulness of B-HCSCS compared to T-HCSCS in controlling pain and specific aspects of PD motor and non-motor deficits for at least one year. View Full-Text
Keywords: cervical spinal cord stimulation; tonic stimulation; burst stimulation; Parkinson’s disease; gait; reaction time; Valsava maneuver cervical spinal cord stimulation; tonic stimulation; burst stimulation; Parkinson’s disease; gait; reaction time; Valsava maneuver
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This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (CC BY 4.0).
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Mazzone, P.; Viselli, F.; Ferraina, S.; Giamundo, M.; Marano, M.; Paoloni, M.; Masedu, F.; Capozzo, A.; Scarnati, E. High Cervical Spinal Cord Stimulation: A One Year Follow-Up Study on Motor and Non-Motor Functions in Parkinson’s Disease. Brain Sci. 2019, 9, 78.

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