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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


Avg Age

Avg PD duration

Indication for SCS


Lead Location

Frequency; pulse width

Follow up period

Pain Scale

Pre ➔ Post


UPDRS—III (Motor Exam)

Additional Comments

Agari and Date 2012a



(range 63–79)


(range 7–39)

Low back and/or lower extremity pain

DBS in 7 cases


5–20 Hz,

210–330 μsec

12 months


8.9 (range 7.8–10) ➔ 2.3 (range 0–3.3)


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




Leg pain



30 Hz, 250 μsec

16 months


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


64.25 ± 5.91

21.25 ± 10.18

Advanced PD



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




Back pain



Program 1:

7 Hz, 450 μsec

Program 2:

7 Hz, 250 μsec

1 month


10 ➔ 2

(post op day 1)


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


65.5 ± 11.1


11.1 ± 5.3

PD or atypical parkinsonism

DBS in 3 cases


Burst (250–500 Hz on; 40 Hz off, 1000 μsec)

12 months



(P < 0.05)

Gait speed P < 0.05

Cadence P < 0.05

Step length P < 0.05

Stride length P < 0.05


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