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Unilateral Extradural Motor Cortex Stimulation Is Safe and Improves Parkinson Disease at 1 Year

Bentivoglio, Anna Rita MD, PhD*; Fasano, Alfonso MD, PhD*,§; Piano, Carla MD*; Soleti, Francesco MD*; Daniele, Antonio MD, PhD*; Zinno, Massimiliano PhD*; Piccininni, Chiara MD*; De Simone, Celestino MD; Policicchio, Domenico MD; Tufo, Tommaso MD; Meglio, Mario MD; Cioni, Beatrice MD

doi: 10.1227/NEU.0b013e318266e6a5
Research-Human-Clinical Studies
Press Release

BACKGROUND: The primary motor cortex, which is part of the corticobasal ganglia loops, may be an alternative option for the surgical treatment of Parkinson disease.

OBJECTIVE: To report on the 1-year safety and efficacy of unilateral extradural motor cortex stimulation in Parkinson disease.

METHODS: A quadripolar electrode strip was extradurally implanted over the motor cortex. Stimulation was continuously delivered through the electrode paddle contralateral to the most affected clinical side. Subjects were prospectively evaluated by the Unified Parkinson's Disease Rating Scale (UPDRS) and the Parkinson's Disease Quality of Life Questionnaire. In addition, an extensive cognitive and behavioral assessment and electroencephalogram recording were performed.

RESULTS: Nine patients were included in this study. No surgical complications or adverse events occurred. Moreover, no cognitive or behavioral changes were observed. Under the off-medication condition, the UPDRS III at baseline was decreased by 14.1%, 23.3%, 19.9%, and 13.2%, at 1, 3, 6, and 12 months, respectively. The motor effects were bilateral, appeared after 3 to 4 weeks of stimulation, and outlasted the stimulation itself for 3 to 4 weeks in 1 case of stimulator accidental switching off. The UPDRS IV was decreased by 40.8%, 42.1%, and 35.5% at 1, 3, and 12 months, respectively. The scores on the Parkinson's Disease Quality of Life Questionnaire were increased at months 3, 6, and 12.

CONCLUSION: Extradural motor cortex stimulation is a safe procedure. After 12 months, the patients demonstrated a moderate improvement of motor symptoms (particularly axial symptoms) and quality of life.

ABBREVIATIONS: DBS, deep brain stimulation

EMCS, extradural motor cortex stimulation

LEDD, levodopa equivalent daily dose

PD, Parkinson disease

STN, subthalamic nucleus

UPDRS, Unified Parkinson's Disease Rating Scale

*Neurology and

Functional and Spinal Neurosurgery, Catholic University, Rome, Italy

§Department of Neuroscience, AFaR-Fatebenefratelli Hospital, Rome, Italy

Correspondence: Beatrice Cioni, MD, Functional and Spinal Neurosurgery, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168 Rome, Italy. E-mail:

Received January 24, 2012

Accepted June 12, 2012

Copyright © by the Congress of Neurological Surgeons