Spinal cord stimulation for gait impairment in Parkinson Disease: scoping review and mechanistic considerations.

Autor:	Singh O; Department of Physical Medicine and Rehabilitation, University of Cincinnati Medical Center, Cincinnati, OH 45219, United States., Carvalho DZ; Department of Neurology, Mayo Clinic, Rochester, MN 55905, United States.; Center for Sleep Medicine, Pulmonary and Critical Care Medicine Division, Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, United States., Espay AJ; James J and Joan A Gardner Center for Parkinson Disease and Movement Disorders, University of Cincinnati Medical Center, Cincinnati, OH 45219, United States., Benarroch EE; Department of Neurology, Mayo Clinic, Rochester, MN 55905, United States., Grewal SS; Department of Neurosurgery, Mayo Clinic, Jacksonville, FL 32224, United States., Pagani-Estévez GL; Interventional and Surgical Pain Management, Cincinnati Veterans Affairs Medical Center, Cincinnati, OH 45219, United States.
Jazyk:	angličtina
Zdroj:	Pain medicine (Malden, Mass.) [Pain Med] 2023 Oct 13; Vol. 24 (Supplement_2), pp. S11-S17.
DOI:	10.1093/pm/pnad092
Abstrakt:	Objective: Advanced Parkinson's Disease (PD) is associated with Parkinson's Disease gait impairment (PDg), which increases the risk for falls and is often treatment-refractory. Subthalamic nucleus (STN) and globus pallidus pars interna (GPi) deep brain stimulation (DBS) often fails to improve axial symptoms like PDg. Spinal cord stimulation (SCS) has been suggested to improve PDg. SCS may benefit PDg by disrupting pathologic beta-oscillations and hypersynchrony in cortico-striatal-thalamic circuits to override excessive inhibition of brainstem locomotor regions. SCS may potentially improve locomotion by acting at any of these levels, either alone or in combination. Methods: We conducted a comprehensive literature search and scoping review, identifying 106 patients in whom SCS was evaluated for PDg. Results: Among the identified patients, 63% carried a pain diagnosis. Overall, the most common stimulation location was thoracic (78%), most commonly T9-T10. Burst (sub-perception) was the most common stimulation modality (59%). Prior treatment with DBS was used in 25%. Motor outcomes were assessed by the Unified Parkinson Disease Rating Scale (UPDRS) III-motor, UPDRS, the Timed Up and Go (TUG), and/or 10-/20-meter walking tests.Among these patients, 95 (90%) had PDg amelioration and improved motor outcomes. Conclusions: Despite small sample sizes, patient heterogeneity, and unblinded evaluations complicating interpretations of efficacy and safety, SCS may be beneficial for at least a subset of PDg. Further research is required to clarify the role of SCS for PDg and the patients most suitable to benefit from this intervention. (© The Author(s) 2023. Published by Oxford University Press on behalf of the American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
Databáze:	MEDLINE
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