title: Spinal cord stimulation for Parkinson's disease: a systematic review.
abstract: Axial symptoms are a late-developing phenomenon in the course of Parkinson's disease (PD) and represent a therapeutic challenge given their poor response to levodopa therapy and deep brain stimulation. Spinal cord stimulation (SCS) may be a new therapeutic approach for the alleviation of levodopa-resistant motor symptoms of PD. Our purpose was to systematically review the effectiveness of SCS for the treatment of motor symptoms of PD and to evaluate the technical and pathophysiological mechanisms that may influence the outcome efficacy of SCS. A comprehensive literature search was conducted using electronic databases for the period from January 1966 through April 2014. The methodology utilized in this work follows a review process derived from evidence-based systematic review and meta-analysis of randomized trials described in the PRISMA statement. Reports examining SCS for the treatment of PD are limited. Eight studies with a total of 24 patients were included in this review. The overall motor score of the Unified Parkinson's Disease Rating Scale in the on/off-stimulation condition remained unchanged in 6 patients and improved in 18 patients after SCS. SCS appears to yield positive results for PD symptoms, especially for impairments in gait function and postural stability. However, evidence is limited and long-term prospective studies will be required to identify the optimal candidates for SCS and the best parameters of stimulation and to fully characterize the effects of stimulation on motor and nonmotor symptoms of PD.
authors.affiliation: Division of Functional Neurosurgery, Department of Neurology, University of São Paulo Medical School (FMUSP), São Paulo, Brazil.
authors.forename: Emerson Magno
authors.initials: EM
authors.lastname: de Andrade
authors.affiliation: Division of Functional Neurosurgery, Department of Neurology, University of São Paulo Medical School (FMUSP), São Paulo, Brazil.
authors.forename: Maria Gabriela
authors.initials: MG
authors.lastname: Ghilardi
authors.affiliation: Division of Functional Neurosurgery, Department of Neurology, University of São Paulo Medical School (FMUSP), São Paulo, Brazil.|Department of Neurology, University of São Paulo Medical School (FMUSP), Rua Dr. Ovıdio Pires de Campos, 785, 01060-970, Sao Paulo, SP, Brazil.
authors.forename: Rubens Gisbert
authors.initials: RG
authors.lastname: Cury
authors.affiliation: Department of Neurology, University of São Paulo Medical School (FMUSP), Rua Dr. Ovıdio Pires de Campos, 785, 01060-970, Sao Paulo, SP, Brazil.
authors.forename: Egberto Reis
authors.initials: ER
authors.lastname: Barbosa
authors.affiliation: Edmond and Lily Safra International Institute of Neuroscience of Natal (ELS-IINN), Natal, RN, Brazil.
authors.forename: Romulo
authors.initials: R
authors.lastname: Fuentes
authors.affiliation: Division of Functional Neurosurgery, Department of Neurology, University of São Paulo Medical School (FMUSP), São Paulo, Brazil.|Department of Neurology, University of São Paulo Medical School (FMUSP), Rua Dr. Ovıdio Pires de Campos, 785, 01060-970, Sao Paulo, SP, Brazil.
authors.forename: Manoel Jacobsen
authors.initials: MJ
authors.lastname: Teixeira
authors.affiliation: Division of Functional Neurosurgery, Department of Neurology, University of São Paulo Medical School (FMUSP), São Paulo, Brazil. fonoffet@usp.br.|Department of Neurology, University of São Paulo Medical School (FMUSP), Rua Dr. Ovıdio Pires de Campos, 785, 01060-970, Sao Paulo, SP, Brazil. fonoffet@usp.br.
authors.forename: Erich Talamoni
authors.initials: ET
authors.lastname: Fonoff
mesh_terms: D006801:Humans; D010300:Parkinson Disease / Q000628:therapy*; D062187:Spinal Cord Stimulation / Q000009:adverse effects / Q000379:methods*
keywords: Dorsal column; Gait function; Parkinson’s disease; Spinal cord stimulation