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