Spinal stimulation for movement disorders

Abstract

Epidural spinal cord stimulation (SCS) is currently proposed to treat intractable neuropathic pain. Since the 1970s, isolated cases and small cohorts of patients suffering from dystonia, tremor, painful leg and moving toes (PLMT), or Parkinson’s disease were also treated with SCS in the context of exploratory clinical studies. Despite the safety profile of SCS observed in these various types of movement disorders, the degree of improvement of abnormal movements following SCS has been heterogeneous among patients and across centers in open-label trials, stressing the need for larger, randomized, double-blind studies. This article provides a comprehensive review of both experimental and clinical studies of SCS application in movement disorders.

Figures

Fig. 1

Medullar lemniscal pathway. (a) Schematic representation of the lemniscal track at different levels of the spinal cord: ascending track coming at each level from the dorsal root ganglia and decussating in the lower medulla. (b) Represents the somatotopic arrangement of the ascending medial lemniscal track (in blue, dorsal), the ascending spinothalamic track (in blue, ventral), and the descending lateral pyramidal track (in red). The epidural electrode is placed along the dorsal aspect of the spinal cord. (c) The somatotopic arrangement has been integrated in the axial computed tomography scan view of a thoracic spine. S = sacral; L = lumbar; Th = thoracic; C = cervical; P = pedicle; TP = transverse process; LA = lamina, SP = spinous process; B = vertebral body

Fig. 2

Thoracic computed tomography (CT) scan. (a) Coronal view; (b) axial view of thoracic spine by CT scan. Red arrow indicates an 8-contact surgical paddle lead located in the dorsal aspect of the epidural space. Ant = anterior; P = pedicle; L = lamina, SP = spinous process; B = vertebral body