Cerebral activity modulation by extradural motor cortex stimulation in Parkinson's disease: a perfusion SPECT study.

R. Cilia, G. Marotta, A. Landi, I. U. Isaias, F. Vergani, R. Benti, E. Sganzerla, P. Gerundini, G. Pezzoli, A. Antonini

Research output: Contribution to journalArticlepeer-review


Extradural motor cortex stimulation (EMCS) has been proposed as alternative to deep brain stimulation (DBS) in the treatment of Parkinson's disease (PD). Its mechanisms of action are still unclear. Neuroimaging evidenced motor cortical dysfunction in PD that can be reversed by therapy. We performed left hemisphere EMCS surgery in six advanced PD patients fulfilling CAPSIT criteria for DBS with the exception of age >70 years. After 6 months, we measured regional cerebral blood flow (rCBF) at rest with SPECT and Tc-99m cysteinate dimer bicisate off-medication with stimulator off and on. Clinical assessment included Unified Parkinson's Disease Rating Scale part II and III, Abnormal Involuntary Movement Scale and mean dopaminergic medication dosage. We used statistical parametric mapping for imaging data analysis. Clinically we observed no mean changes in motor scales, although blinded evaluation revealed some benefit in individual patients. We found significant rCBF decrements in the pre-central gyrus, pre-motor cortex and caudate nucleus bilaterally, left prefrontal areas and right thalamus. Perfusion increments were found in cerebellum bilaterally. EMCS determined significant modulation of neuronal activity within the cortico-basal ganglia-thalamo-cortical motor loop in our cohort of advanced PD patients. However, these effects were paralleled by mild and variable clinical efficacy.

Original languageEnglish
Pages (from-to)22-28
Number of pages7
JournalEuropean Journal of Neurology
Issue number1
Publication statusPublished - Jan 2008

ASJC Scopus subject areas

  • Medicine(all)


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