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. 2021 Mar 26;11(4):416.
doi: 10.3390/brainsci11040416.

Extradural Motor Cortex Stimulation in Parkinson's Disease: Long-Term Clinical Outcome

Carla Piano  1 , Francesco Bove  1   2 , Delia Mulas  3 , Enrico Di Stasio  4   5 , Alfonso Fasano  6   7   8 , Anna Rita Bentivoglio  1   2 , Antonio Daniele  1   2 , Beatrice Cioni  9 , Paolo Calabresi  1   2 , Tommaso Tufo  9
Affiliations

Extradural Motor Cortex Stimulation in Parkinson's Disease: Long-Term Clinical Outcome

Carla Piano et al. Brain Sci. .

Abstract

Previous investigations have reported on the motor benefits and safety of chronic extradural motor cortex stimulation (EMCS) for patients with Parkinson's disease (PD), but studies addressing the long-term clinical outcome are still lacking. In this study, nine consecutive PD patients who underwent EMCS were prospectively recruited, with a mean follow-up time of 5.1 ± 2.5 years. As compared to the preoperatory baseline, the Unified Parkinson's Disease Rating Scale (UPDRS)-III in the off-medication condition significantly decreased by 13.8% at 12 months, 16.1% at 18 months, 18.4% at 24 months, 21% at 36 months, 15.6% at 60 months, and 8.6% at 72 months. The UPDRS-IV decreased by 30.8% at 12 months, 22.1% at 24 months, 25% at 60 months, and 36.5% at 72 months. Dopaminergic therapy showed a progressive reduction, significant at 60 months (11.8%). Quality of life improved by 18.0% at 12 months, and 22.4% at 60 months. No surgical complication, cognitive or behavioral change occurred. The only adverse event reported was an infection of the implantable pulse generator pocket. Even in the long-term follow-up, EMCS was shown to be a safe and effective treatment option in PD patients, resulting in improvements in motor symptoms and quality of life, and reductions in motor complications and dopaminergic therapy.

Keywords: Parkinson’s disease; motor cortex stimulation; movement disorders; neuromodulation.

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Conflict of interest statement

A.F. received honoraria from Medtronic. All other authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Placement of quadripolar electrode strips over the motor cortices. (a) Preoperative brain MRI. (b) Postoperative brain CT scan. (c) Postoperative skull X-ray. R = right; L = left.
Figure 2
Figure 2
Motor efficacy of extradural motor cortex stimulation (EMCS) in the off-med condition in all patients, evaluated at different times after the implant. Error bars represent standard deviation. * p < 0.05 at comparisons between preoperative and postoperative scores, analyzed by means of the Wilcoxon signed-rank test.
Figure 3
Figure 3
Efficacy of EMCS on motor complications (a) and reduction in dopaminergic therapy (b) in all patients, evaluated at different times after the implant. Error bars represent standard deviation. * p < 0.05 at comparisons between preoperative and postoperative scores, analyzed by means of the Wilcoxon signed-rank test.
Figure 4
Figure 4
Impact of EMCS on daily living activities (a) and quality of life (b) in all patients, evaluated at different times after the implant. Error bars represent standard deviation. * p < 0.05 at comparisons between preoperative and postoperative scores, analyzed by means of the Wilcoxon signed-rank test.
See this image and copyright information in PMC

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