title: Extradural motor cortex stimulation in Parkinson's disease.
abstract: Extradural motor cortex stimulation (EMCS) is a surgical procedure proposed for patients with advanced Parkinson's disease (PD) who cannot undergo deep brain stimulation (DBS). Five PD patients with motor fluctuations and dyskinesia underwent EMCS of the left hemisphere. All fulfilled CAPSIT criteria for DBS, with the exception of age > 70 years. Patients were assessed preoperatively and 6 months after surgery on and off medications, with stimulator on, and 2 weeks later with stimulator off. Outcome measures included changes in mean medication dosage (levodopa and dopamine agonists), Unified Parkinson's Disease Rating Scale (UPDRS Parts II-III and Item 39), and dyskinesias (Abnormal Involuntary Movements Scale [AIMS]). We found no significant mean changes following EMCS. However, there was a trend for a reduction of mean daily medication intake (-30%) and AIMS (-19%). There were 3 patients who reported reduced OFF time (UPDRS Item 39) and 4 of 5 who felt a subjective benefit in stability and gait. In our PD cohort, EMCS induced no objective benefit, although some subjective improvement was reported mostly on axial symptoms.
authors.affiliation: Parkinson Institute, Istituti Clinici di Perfezionamento, Milan, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Cilia
authors.forename: Andrea
authors.initials: A
authors.lastname: Landi
authors.forename: Francesco
authors.initials: F
authors.lastname: Vergani
authors.forename: Erik
authors.initials: E
authors.lastname: Sganzerla
authors.forename: Gianni
authors.initials: G
authors.lastname: Pezzoli
authors.forename: Angelo
authors.initials: A
authors.lastname: Antonini
mesh_terms: D000368:Aged; D000978:Antiparkinson Agents / Q000627:therapeutic use; D004558:Electric Stimulation / Q000379:methods*; D005260:Female; D006801:Humans; D007980:Levodopa / Q000627:therapeutic use; D008297:Male; D009044:Motor Cortex / Q000528:radiation effects*; D010300:Parkinson Disease / Q000473:pathology* / Q000628:therapy*; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000978:Antiparkinson Agents; D007980:Levodopa