Objective: We aim to study the effect of spinal cord stimulation over gait in parkinson disease without pain nor neuropathy.

Background: Axial symptoms in the course of Parkinson’s disease (PD) represent a therapeutic challenge given their poor response to levodopa therapy, deep brain stimulation or other therapeutic approaches.

In rodent models of PD high frequency stimulation at the upper thoracic level can restore locomotion. Spinal cord stimulation (SCS) is currently proposed to treat intractable neuropathic pain. Since the 1970’s a positive effect of SCS on motor symptoms was reported on isolated cases or small cohorts of patients suffering from both Parkinson’s disease and resistant pain. 

Methods: We analyzed the score of stand-walk-sit test (SWS), MDS-UPDRS part III, PDQ39, freezing of gait questionnaire on 5 patients without pain or neuropathy before and after SCS. At J1, surgical leads with 8 electrodes were inserted into the peridural space under general anesthesia at the level of the lumbar bulge under the control of the brightness enhancer. Then the leads were connected to a pulse generator that contains battery and programmable components of the device. The level, shape and size of the leads were similar for the 5 patients. A subthreshold continuous stimulation (without paresthesia) 300 μs 100 Hz was chosen. Videos of patients at J0, J3, J15 and J60 were randomly analyzed by a blinded neurologist.

Results: An stastistically significant improvement compared to baseline was observed for SWS, MDS-UPDRS part III at J15 and J60 (p<0.05).

Conclusions: Our results support the hypothesis of a clinical benefit of spinal stimulation on gait disorders in Parkinson desease.

It is hypothesized that SCS generate its therapeutic effect not only through electrophysiological change at the dorsal column level but also on deep nuclei structures of the brainstem and the forebrain. Some studies suggest that the level of dopaminergic responses may account for the level of motor effect following SCS. The effectiveness of the SCS over axial symptoms suggestive of extra nigral non dopaminergic lesion suggests a non dopaminergic action.

References: E.M. de Andrade. Spinal cord stimulation for Parkinson’s disease: a systematic review. Neurosurg Rev. 2016; 39 (1):27-35.

C.Thiriez. Spinal stimulation for movement disorders. Neurotherapeutics. 2014;11(3):543-52.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/spinal-cord-stimulation-as-therapeutic-option-in-gait-disorder-in-parkinson-disease/