title: Unilateral subdural motor cortex stimulation improves essential tremor but not Parkinson's disease.
abstract: Epidural motor cortex stimulation has been reported to be effective in treating some movement disorders. Nevertheless, clinical results have been variable and no double-blinded evaluations have been reported. The aim of this study was to investigate efficacy and safety of unilateral subdural motor cortex stimulation in patients with essential tremor and Parkinson's disease. Six patients with essential tremor and five parkinsonian patients were selected. Craniotomy was performed under local anaesthesia with conscious sedation. A four contact electrode (Resume II model 3587, Medtronic, Inc) was positioned on the motor cortex, after identification of the area with direct monopolar cortical stimulation. Soon after surgery, a variety of different settings of stimulation were assessed using standard rating scales to select the optimal stimulation parameters. The effects of chronic stimulation were evaluated in both groups of patients after 3 months (double-blinded fashion) and 1 year (open fashion). In essential tremor, contralateral hand tremor scores significantly improved (P = 0.04) with stimulation during the double-blinded study, whereas in Parkinson's disease, there were no changes in the OFF medication/on stimulation motor scores compared with off stimulation. At 1 year, tremor was improved by stimulation in two out of three patients with essential tremor available at follow-up, whereas no improvement was observed in the five parkinsonian patients. One parkinsonian patient had a cortical venous infarct. Three other patients had self-limiting seizures with aggressive trials of stimulation in the period of dosage selection. These findings suggest that unilateral subdural motor cortex stimulation may be useful for contralateral hand tremor in selected patients with essential tremor but was not effective in improving parkinsonian signs in our series.
authors.affiliation: Movement Disorders Centre, Division of Neurology, Department of Medicine, University of Toronto, Toronto Western Hospital, University Health Network,Toronto, ON M5T2S8, Canada. elena.moro@uhn.on.ca
authors.forename: Elena
authors.initials: E
authors.lastname: Moro
authors.forename: Jason M
authors.initials: JM
authors.lastname: Schwalb
authors.forename: Panida
authors.initials: P
authors.lastname: Piboolnurak
authors.forename: Yu-Yan W
authors.initials: YY
authors.lastname: Poon
authors.forename: Clement
authors.initials: C
authors.lastname: Hamani
authors.forename: Serena W
authors.initials: SW
authors.lastname: Hung
authors.forename: Tamara
authors.initials: T
authors.lastname: Arenovich
authors.forename: Anthony E
authors.initials: AE
authors.lastname: Lang
authors.forename: Robert
authors.initials: R
authors.lastname: Chen
authors.forename: Andres M
authors.initials: AM
authors.lastname: Lozano
mesh_terms: D000368:Aged; D001703:Biophysics; D004311:Double-Blind Method; D004599:Electric Stimulation Therapy / Q000379:methods*; D004567:Electrodes, Implanted; D020329:Essential Tremor / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D007839:Functional Laterality / Q000502:physiology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009044:Motor Cortex / Q000502:physiology*; D009483:Neuropsychological Tests; D010300:Parkinson Disease / Q000628:therapy*; D012189:Retrospective Studies; D013355:Subdural Space / Q000502:physiology; D013997:Time Factors; D016896:Treatment Outcome