title: Motor cortex stimulation for levodopa-resistant akinesia: case report.
abstract: We treated a patient with levodopa-resistant akinesia with motor cortex stimulation (MCS), and she showed dramatic improvement more than 1 year. On admission, the patient presented severe akinesia and gait disturbance without tremor and rigidity, and did not respond to levodopa test. The patient was suspected pure akinesia and progressive supranuclear palsy. First, high-frequency rTMS of primary motor cortex was examined, and showed the dramatic improvement. Next, chronic subdural electrodes were implanted over the motor cortex bilaterally. One year after surgery, the Unified Parkinson's Disease Rating Scale had improved remarkably, and she could walk four times faster than before. The H2 15O PET study showed a significant increase of rCBF in the left SMA and right dorsolateral prefrontal cortex after bilateral MCS. MCS may be an alternative treatment for patients with akinesia, including those with PD, and particularly for levodopa-resistant patients, who respond well to rTMS.
authors.affiliation: Department of Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Tani
authors.forename: Youichi
authors.initials: Y
authors.lastname: Saitoh
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Kishima
authors.forename: Satoru
authors.initials: S
authors.lastname: Oshino
authors.forename: Jun
authors.initials: J
authors.lastname: Hatazawa
authors.forename: Kazuo
authors.initials: K
authors.lastname: Hashikawa
authors.forename: Toshiki
authors.initials: T
authors.lastname: Yoshimine
mesh_terms: D000368:Aged; D046690:Deep Brain Stimulation / Q000379:methods*; D004306:Dose-Response Relationship, Immunologic; D005260:Female; D006801:Humans; D009044:Motor Cortex / Q000503:physiopathology* / Q000528:radiation effects*; D009069:Movement Disorders / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D012720:Severity of Illness Index