title: Chronic cortical stimulation for amyotropic lateral sclerosis: a report of four consecutive operated cases after a 2-year follow-up: technical case report.
abstract: OBJECTIVE
  From April to July 2002, four consecutive patients affected by amyotrophic lateral sclerosis (ALS) were surgically treated with bilateral chronic cortical stimulation..
  
  
  METHODS
  The preoperative diagnostic assessment was based on the results of a neurological examination, integrated by the ALS functional rating scale, electromyography, magnetic resonance imaging, and single-photon emission computed tomography (SPECT). In particular, SPECT provided a remarkable contribution in terms of its ability to demonstrate specific morphological and metabolic ALS lesions of the brain.
  
  
  METHODS
  The postoperative neurological follow-up was based mainly on the assessment of neurological status and the ALS functional rating scale, together with SPECT. Two years after surgery, at clinical examination, two patients demonstrated mild progression of their illness, and SPECT findings disclosed complete disappearance of ALS cerebral lesions, with apparent recovery of brain anatomic integrity. The third patient committed suicide. In the fourth patient, the disease seemed to have progressed inexorably at the time of clinical and SPECT monitoring, after transient improvement during the first 3 months after surgery..
  
  
  CONCLUSIONS
  These preliminary results are surprising, because they suggest that chronic cortical stimulation can play a role against ALS and deserve confirmation in larger numbers of patients and for a longer follow-up. We present the theoretical grounds for these findings, as well as the diagnostic and surgical procedures and results..
authors.affiliation: Department of Neurosurgery, Sandro Pertini Hospital, Rome, Italy. neurocarmelos@yahoo.it
authors.forename: Carmelo
authors.initials: C
authors.lastname: Sidoti
authors.forename: Umberto
authors.initials: U
authors.lastname: Agrillo
mesh_terms: D000690:Amyotrophic Lateral Sclerosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D002540:Cerebral Cortex / Q000502:physiology*; D046690:Deep Brain Stimulation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods