Table 3.
Spinal cord stimulation studies in patients with Parkinson´s disease.
| Author | Study population | SCS level | Follow-up | Findings |
|---|---|---|---|---|
| Thevathasan et al., 2010 | Two PD patients with advanced disease | Cervical SCS (Level C2) at 130–300 Hz; 240– 200 μsec | 10 days | There were no differences in gait function (10 m walk) |
| Fénelon et al., 2012 | One PD patient with failed back surgery syndrome | Thoracic SCS (Level T9–10) at 100–130 Hz; 410 μsec | 29 months | The motor score and subscores of UPDRS-III were reduced by 50% on average when SCS was switched on in off-drug condition. Waking time was reduced by 21%. |
| Agari and Date 2012 | Fifteen PD patients with low back and/or lower limb pain. Seven patients had DBS. | Thoracic SCS (Level T7–12) at 5–20 Hz, 210–330 μsec | 12 months | Patients showed significant improvement in pain intensity, postural stability and gait (timed up and go and 10-m walk) at 3 months and 1 year after surgery. |
| Landi et al., 2012 | One PD patient with DBS and lower limb pain | Thoracic SCS (Level T9–10) at 30 Hz, 250 μsec | 16 months | Patient showed significant improvement in pain intensity and tome to walk 20-m (reduced by 20%). The UPDRS-III did not change. Quality of life improved by 60%. |
| Hassan et al., 2013 | One PD patient with refractory neck and upper limb pain | Cervical SCS (Level C2) at 40 Hz; 500 μsec | 24 months | Patients showed significant improvement in pain intensity, UPDRS-III (reduced by 41%) and 10-m walk test (reduced by 35%) after 2 years. |
| Nishioka and Nakajima, 2015 | Three PD patients with refractory low back and lower limb pain | Thoracic and lumbar SCS (Level T8–L1) at 5–65 Hz; 420–450 μsec | 12 months | Patients showed significant improvement in pain intensity, UPDRS-III scores including rigidity and tremor. Gait was not assessed. |
| Pinto de Souza et al., 2017 | Four PD patients with gait disturbances previously treated with DBS | Thoracic SCS (Level T2–4) at 300 Hz; 90 μsec. | 6 months |
Patients had ~50–65% improvement in gait measurements and 35–45% in UPDRS III and quality-of-life scores. To analyze placebo effect, blinded SCS was delivered at either 60 or 300 Hz; despite similar paresthesia, gait improvement was only observed with 300 Hz. |
| Akiyama et al., 2017 | One PD patient with advanced disease and DBS with painful camptocormia with Pisa syndrome |
Thoracic SCS (Level T8) at Program 1: 7 Hz, 450 μsec Program 2: 7 Hz, 250 μsec |
1 month | Patients showed significant improvement in pain intensity, UPDRS-II (reduced by 29%) and timed up and go (reduced by 53%). Camptocormia also improved observed by angles of forward flexion from the vertical axis. |
| Kobayashi et al., 2018 | One PD patient with refractory low back | Thoracic SCS (Level T6–8) at Burst stimulation (inter-burst rate: 40 Hz, intra-burst rate: 500 Hz); 1000 μsec | 2 weeks | BurstDR stimulation improved back pain, gait speed and the stooping posture. The UPDRS-III reduced by 70%. |
| Samotus et al., 2018 | Five PD patients with gait disturbances and freezing of gait | Thoracic SCS (Level T8–10) 30–130 Hz; 300–400 μsec | 6 months | Mean step length, stride velocity, and sit-to-stand improved by 38.8%, 42.3%, and 50.3%, respectively, Mean UPDRS, Freezing of Gait Questionnaire, and activities-specific balance confidence scale scores improved by 33.5%, 26.8%, and 71.4%, respectively. |
| Mazzone et al., 2019 | Eighteen patients with PD or atypical parkinsonism; patients with and without back pain. Three patients had DBS. | Cervical SCS (Level C2–3) at Tonic (135–185 Hz; 60–210 μsec) or Burst (inter-burst rate: 40 Hz, intra-burst rate: 500 Hz) stimulation | 12 months | Both stimulation protocols improved the outcomes. Burst was more effective than tonic stimulation in reducing pain, UPDRS scores and gait. A slight decrease of effectiveness for pain and motor control was observed at the last follow-up for both waveforms, but burst mode showed attenuated decrease. |
| Samotus et al., 2020 | Four PD patients with gait disturbances and freezing of gait | Thoracic SCS (Level T8–10) 30–130 Hz; 300–400 μsec | 36 months | Participants demonstrated a reduction in the number of FOG episodes during straight walking at 3-years compared to pre-SCS. Mean FOG-Q and PDQ-8 scores were reduced by 18.3% and by 21.9%; other gait parameters showed great variability between the patients. |
| Furusawa et al., 2020 | Five PD patients with lower back pain | Thoracic SCS (Level T8–10) at Burst stimulation (inter-burst rate: 40 Hz, intra-burst rate: 500 Hz); 1000 μsec | 6 months | BurstDR stimulation improved back pain, gait speed and the total UPDRS-III. FOG and tremor scores did not change significantly after SCS. |
| Prasad et al., 2020 | Six PD patients without pain | Thoracic SCS (Level T10) | 12 months | There was no clinically meaningful effect on patients’ mobility. |
| Cury et al., 2020 | One PD patient without pain | Thoracic SCS (Level T2–4) at continuous or cycling stimulation (cycling mode: 15 min on-/15 min-off-stimulation) | 6 months | Patient did not improve at continuous stimulation but improved the speed and the FOG on the cycling mode |
PD Parkinson’s disease, FOG freezing of gait, SCS spinal cord stimulation, UPDRS-III Unified Parkinson’s Disease Rating Scale part III, FOG-Q freezing of gait questionnaire, PDQ-8 Parkinson’s Disease Questionnaire.