Motor cortex stimulation for levodopa-resistant akinesia: Case report

• Published in: Movement disorders 2007-08, Vol.22 (11), p.1645-1649
• Main Authors: Tani, Naoki, Saitoh, Youichi, Kishima, Haruhiko, Oshino, Satoru, Hatazawa, Jun, Hashikawa, Kazuo, Yoshimine, Toshiki
• Format: Article
• Language: English
• Subjects: Aged; akinesia; Biological and medical sciences; Deep Brain Stimulation - methods; Dose-Response Relationship, Immunologic; Drug toxicity and drugs side effects treatment; Female; Humans; Medical sciences; Motor Cortex - physiopathology; Motor Cortex - radiation effects; motor cortex stimulation; Movement Disorders - pathology; Movement Disorders - physiopathology; Movement Disorders - therapy; Neurology; Pharmacology. Drug treatments; repetitive transcranial magnetic stimulation; Severity of Illness Index; Toxicity: nervous system and muscle; Tumors of the nervous system. Phacomatoses
• ISSN: 0885-3185; 1531-8257
• DOI: 10.1002/mds.21593

We treated a patient with levodopa‐resistant akinesia with motor cortex stimulation (MCS), and she showed dramatic improvement more than 1 year. On admission, the patient presented severe akinesia and gait disturbance without tremor and rigidity, and did not respond to levodopa test. The patient was suspected pure akinesia and progressive supranuclear palsy. First, high‐frequency rTMS of primary motor cortex was examined, and showed the dramatic improvement. Next, chronic subdural electrodes were implanted over the motor cortex bilaterally. One year after surgery, the Unified Parkinson's Disease Rating Scale had improved remarkably, and she could walk four times faster than before. The H215O PET study showed a significant increase of rCBF in the left SMA and right dorsolateral prefrontal cortex after bilateral MCS. MCS may be an alternative treatment for patients with akinesia, including those with PD, and particularly for levodopa‐resistant patients, who respond well to rTMS. © 2007 Movement Disorder Society