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Table 3 Salvage spinal cord stimulation data in patients with loss of efficacy to deep brain stimulation

From: Spinal cord stimulation in Parkinson’s disease: a review of the preclinical and clinical data and future prospects

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
Agari and Date 2012a 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
no change
Large series of 15 patients with advanced Parkinson’s disease with 7 patients having DBS. No subgroup analysis was performed for only the DBS patients. 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.
Landi et al. 2013 1 65 8 Leg pain DBS T9–10 30 Hz, 250 μsec 16 months VAS
Improved up to 70%
Time to 20 m walk Decreased 20% No change Patient with DBS demonstrated improved walking speed after SCS and did not need assistance to walk, although it is unclear the degree of assistance necessary to ambulate prior to stimulation. UPDRS III on versus off condition was unchanged after SCS surgery. Subjective evaluation of quality of life (EQ-VAS) also improved 60%.
Pinto de Souza et al. 2017 4 64.25 ± 5.91 21.25 ± 10.18 Advanced PD DBS T2–4 300 Hz
90 μsec
6 months TUG: P = 0.006
20 m walk: P = 0.02
Steps in 20 m walk: P = 0.009
P = 0.03 Improvement in locomotion occurred within minutes after stimulation onset and lasted for duration of study with no apparent loss of benefit over time. Patients were kept on their normal DBS settings during the study. To deter placebo effect of open label design and patient reported stimulation-induced paresthesia, blinded experience where SCS was randomly delivered at either 60 or 300 Hz; despite similar paresthesia, gate improvement was only documented with SCS was delivered at 300 Hz.
Akiyama et al. 2017 1 65 12 Back pain DBS T8 Program 1:
7 Hz, 450 μsec
Program 2:
7 Hz, 250 μsec
1 month VAS
10 ➔ 2
(post op day 1)
TUG
Pre 15 s
Post 7 s
No change Patient who had previously done well with carbidopa/levodopa, cabergoline, and deep brain stimulation underwent SCS for painful camptocormia with Pisa. It was noted that 1 year after commencing DBS, camptocormia had disappeared completely but then reappeared at 2 years after commencing DBS which prompted SCS for pain. After SCS implant, TUG improved, and although UPDRS-III did not change, UDPRS-II (based on activities of daily living) significantly improved from 25 pre-SCS to 12 at day 29. Camptocormia was also noted to improve as measured by angles of forward flexion from the vertical axis.
Mazzone et al. 2019a 12 65.5 ± 11.1 11.1
11.1 ± 5.3
PD or atypical parkinsonism DBS in 3 cases C2–3 Burst (250–500 Hz on; 40 Hz off, 1000 μsec) 12 months VAS
Improved
(P < 0.05)
Gait speed P < 0.05
Cadence P < 0.05
Step length P < 0.05
Stride length P < 0.05
Burst
P < 0.001
See Table 1 for additional group of non-DBS patients. There were 3 patients refractory to DBS who received Burst stimulation. No subgroup analysis was performed for only the DBS patients. The authors found differences motor scores, gait, and pain in the post-implant acute, 3, 6, and 12 months follow up data. Overall in the Burst group, L-dopa therapy was reduced 835.0 ± 310.1 mg to 730 ± 273.7 mg per day.
  1. Headings: PD Parkinson Disease, DBS deep brain stimulation, Pain Pre ➔ Post before SCS implant ➔ pain at the end of the reported follow up time, TUG Timed up and go, UPDRS Unified Parkinson disease rating scale. Other abbreviations: Hz Hertz, μsec microseconds, m meters, VAS visual analog scale
  2. aData also seen in Table 1 or Table 2; added to Table 3 in order to be inclusive of all DBS patients