Table 2 Thoracic spinal cord stimulation data
Author & Article | N | Avg Age | Avg PD duration | Indication for SCS | DBS | Lead Location | Frequency; pulse width | Follow up period | Pain Scale Pre ➔ Post | Gait | UPDRS—III (Motor Exam) | Additional Comments |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
Fénelon et al. 2012 | 1 | 74 | 5 | FBSS | No | T9–10 | 100–130 Hz 410 μsec | 29 months | VAS off drug 6.9 ± 1.0 ➔ 1.9 ± 0.2 | 7 m walk and back. Off drug 29.3 ± 2.3 s ➔ 23.0 ± 6.3 s | Off drug 56.7 ± 3.3 ➔ 29.7 ± 2.5 | All 4 examinations were performed while SCS was switched on or off for 30–60 min and the reported number is the average of the 4 examinations. Surface EMG showed amplitude reduction but no change in tremor frequency or pattern. |
Agari and Date 2012 | 15 | 71.1 (range 63–79) | 17.2 (range 7–39) | Low back and/or lower extremity pain | DBS in 7 cases | T7–12 | 5–20 Hz, 210–330 μsec | 12 months | VAS 8.9 (range 7.8–10) ➔ 2.3 (range 0–3.3) | TUG 3 mo P < 0.01 1 year P > 0.05 10 m walk 3 mo P < 0.01 1 year P < 0.05 | 3 month P < 0.05 1 year P > 0.05 | Large series of 15 patients with advanced Parkinson’s disease with 7 patients having DBS. Follow-up was 1 year and patients showed significant improvement in pain level and gait. Motor performance was significantly improved at 3 months but not at 1 year per UDPRS-III. |
Nishioka and Nakajima 2015 | 3 | 74.3 ± 6.7 | 9.3± 4.0 | Back Pain & leg pain | No | T8-L1 | 5–65 Hz 420–450 μsec | 12 months | VAS 8.7 ± 1.5➔ 3.7 ± 0.6 P = 0.04 | None | 37.0 ± 5.3 ➔ 24.7 ± 5.8 P = 0.03 | At 1 year follow up, SCS led to amelioration of chronic refractory pain and PD symptoms such as rigidity and tremor (scores based on UPDRS). Mental status did not significantly improve per MMSE (p = 0.19), and gait was not examined. |
Kobayashi et al. 2018 | 1 | 74 M | 3 | Back Pain | No | T6–8 | BurstDR 40 Hz with five spikes of 500 Hz burst; 1000 μsec | 2 weeks | SF-MPQ 47 ➔ 18 | None | 20 to 6 | BurstDR improved LBP, gait, and stooping posture. Patient showed improvement of low back pain and parkinsonism as well as mental health measured by Short-Form 36 (SF36 27.7 pre-SCS to 49.1 post-SCS), which was postulated to be related to the mechanism of BurstDR in both the lateral discriminatory pain system and the medial affective pain experience. Author described no financial disclosures. |
Samotus et al. 2018 | 5 | 71.2 ± 9.8 | 14 ± 3.7 | Parkinson Disease | No | T8–10 | 30–130 Hz, 300–400 μsec | 6 months | NA | Step length P > 0.16 Mean stride velocity P = 0.05 sit-to-stand P = 0.04 | 32 ± 11.7 ➔ 21.4 ± 10.8 (P = 0.02) | Patients with freezing of gait underwent SCS for PD; pain state not noted. Spinal cord stimulation combinations (200–500 μs/30–130 Hz) at suprathreshold intensity were tested and it was found that setting combinations of 300–400 μs/30–130 Hz provided gait improvements. In addition to step length and motor score improvements, the mean number of freezing-of-gait episodes reduced significantly from 14.8 ± 15.4 pre-SCS to 0.2 ± 1.7 at 6 months post-SCS. Three of the 5 patients also required a mean reduction of daily levodopa by 115 mg by 6 months due to dyskinesias which were presumed to be due to dopamine excess. |