Therapeutic extradural cortical stimulation for Parkinson's Disease: report of six cases and review of the literature.
OBJECTIVE
We report our experience and results with extradural cortical stimulation (ECS) in the surgical treatment of Parkinson's Disease (PD). Besides, we review the literature supporting the use of this technique.


METHODS
Six patients with advanced PD and exclusion criteria for Deep Brain Stimulation (DBS) were included in our ECS protocol. With the aid of functional MRI and somato-sensory evoked potentials monitoring, the motor cortex projection over the scalp was drawn. Finally, under local anesthesia a stimulation lead was placed in the epidural space overlying the central sulcus.


RESULTS
Patients showed mild daily life activities improvement with a slightly lower levodopa equivalent dose, but UPDRS part III scores showed no significant modification.


CONCLUSIONS
Despite ECS is a minimally invasive surgical technique, our results only support its use in selected patients with advanced PD, in whom this therapy may be modestly effective. More experimental studies regarding the neuromodulation of the basal ganglia-cortex loops are required to optimize its clinical application.
Gutiérrez
Julio C
JC
Functional Neurosurgery Unit, Department of Surgical Neurology, Hospital Universitario Central de Asturias, Av. Julián Clavería s/n, Oviedo 33006, Spain. gutierrezhcas@hotmail.com
Seijo
Fernando J
FJ
Alvarez Vega
Marco A
MA
Fernández González
Fernando
F
Lozano Aragoneses
Beatriz
B
Blázquez
Marta
M
D000368:Aged; D000978:Antiparkinson Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D000075202:Contraindications; D046690:Deep Brain Stimulation; D004388:Dura Mater; D004599:Electric Stimulation Therapy / Q000379:methods*; D004569:Electroencephalography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007980:Levodopa / Q000627:therapeutic use; D008297:Male; D009044:Motor Cortex / Q000503:physiopathology*; D010300:Parkinson Disease / Q000628:therapy*; D012720:Severity of Illness Index; D016896:Treatment Outcome
D000978:Antiparkinson Agents; D007980:Levodopa