Atlanta, Georgia (PRWEB) May 10, 2014
INTRODUCTION: Researchers have suspected that SCS may have potent effects on cortical neuronal activity and have theorized that higher frequency stimulation may benefit the patient with PD. This single case report describes symptom reduction and activity improvement in a patient with PD using Ultra High Frequency SCS.
In Science, March 20, 2009, Fuentes, Petersson, Nicolelis, et al, tested SCS in rats with induced PD, finding locomotion improved during stimulation and suggesting SCS might become a less invasive treatment for Parkinson’s symptoms. Maximum stimulation frequency was 300 Hz throughout the testing.
In June 2010, Pucci, Vasuvedan, Cheng, et al, presented data at the ASSFN meeting in New York, reporting on two patients with PD with previously implanted thoracic SCS leads for pain management. Beneficial SCS effect on walking time was demonstrated with a higher stimulation frequency, but maximum frequency was 130 Hz and leads were thoracic.
METHOD: On July 19, 2010, a 56-year-old female patient with intractable left arm, neck, and shoulder pain plus PD diagnosed in 2002, underwent trial percutaneous insertion of two cervical epidural leads using the Medtronic Compact octrode array with tips of electrodes placed in the midline at C3-C4 (see Figure 1). Paresthesiae to painful areas were confirmed at insertion and leads were tunneled for the trial. In PACU post-insertion, pain relief during stimulation was confirmed; then a systematic testing of electrode combination, frequency, pulse-width, and amplitude was carried out to test for improvement in PD symptoms (see Table 1). Pain relief was noted with multiple settings and undesired paresthesiae were reduced using a “protected cathode” electrode choice (+-+), but resting tremors of the hands never changed. However, as frequency increased and pulse-width diminished, the patient noticed an overall sense of “well-being” with reduced muscle rigidity, improved posture, and perceived increase in speed of activity. Two programs using 780 Hz and 860 Hz, with pulse-width of 110 μs and 120 μs respectively, were provided to the patient for home testing. Subsequently, the program of 860 Hz, pulse-width 120 μs, with amplitudes ranging from 2.4 to 4 volts was chosen by the patient for 95% of the trial. The only pre-trial medication, low dose Segeline, was continued uninterrupted.
RESULTS: On day 2 of SCS trial, the patient was tested by a doctorate physical therapist (DPT) trained in PD evaluation, using Dynamic Gait Index, Berg Balance Scale, and Timed Up and Go. The results are shown in Table 2..
Repeat testing by the same PT was performed on July 23, 2010 (day 5 of the trial) but with PT blinded to SCS use. “Timed Up and Go” testing showed similar results to initial testing on day 2. The timed portions of the Berg Balance Scale were performed with results shown in Table 3.
Testing on both days consistently demonstrated improvement of locomotion, speed, agility, and balance. Though not tested by the therapist, lower frequency stimulation (40 – 100 Hz) that provided pain relief did not enhance balance or locomotion and was rejected by the patient.
At no time during the six-day SCS trial was tremor affected. Voice volume and timber were improved subjectively and per observation. Daily evaluation of hand writing, plus drawing of circles and spirals, showed no improvement with SCS off or on (Figs. 2 – 5). Videotaped climbing of stairs showed markedly improved speed, agility, competence of balance, and reduced fatigability with SCS on versus off.
CONCLUSIONS: Prior to this case, the use of SCS to improve symptoms of PD in humans has not been reported. Cervical placement of SCS leads and Ultra High Frequency stimulation were shown to improve balance, agility, and speed, reduce rigidity and fatigability in this patient, but tremor was not reduced. SCS is a neuromodulation technique that can be tested for patient reaction prior to permanent implantation. This is a single case, but it is hoped that additional reports of SCS benefit for PD will be forthcoming.
FOLLOW UP: The trial leads were removed on day 6. The patient underwent permanent implant of two percutaneously placed Medtronic Compact octrode leads with Restore Ultra Medtronic IPG on September 3, 2010. PT testing one week later showed additional improvement of balance and agility, and reduced rigidity, but no improvement in tremor control. Presently, two Ultra High Frequency (780 Hz and 860 Hz) programs are used daily by the patient for pain control and reduction of PD symptoms. Falling, which happened weekly, has not occurred since SCS implant. Tremor continues unchanged.
To view the published poster, visit http://www.thephysicians.com.