Submited on: 24 Jan 2014 11:42:57 AM GMT
Published on: 24 Jan 2014 12:46:26 PM GMT
 
Epidural motor cortex stimulation for Parkinsons
Posted by Dr. Ira M Goldstein on 28 Apr 2014 01:53:09 AM GMT Reviewed by Author Invited Reviewers

  • What are the main claims of the paper and how important are they?

    Unilateral epidural cortical stimulation was performed in 10 patients with advanced idiopathic PD of at least 5 years' duration. Significant improvement in Parkinson's symptoms of tremor, dystonia, and dyskinesia with virtually no complications. Efficacy seen with durability to at least 36 months' followup.


  • Are these claims novel? If not, please specify papers that weaken the claims to the originality of this one.

    No.

    Therapeutic extradural cortical stimulation for Parkinson's Disease: report of six cases and review of the literature.

    Gutiérrez JC, et al.

    Clin Neurol Neurosurg. 2009 Oct;111(8):703-7. doi: 10.1016/j.clineuro.2009.06.006. Epub 2009 Jul 14. Review.

    PMID: 19604625

    Neuropsychologic assessment of patients with advanced Parkinson disease submitted to extradural motor cortex stimulation.

    Munno D, et al.

    Cogn Behav Neurol. 2007 Mar;20(1):1-6.

    PMID: 17356336

    Further experience with extradural motor cortex stimulation for treatment of advanced Parkinson's disease. Report of 3 new cases.

    Pagni CA, et al.

    J Neurosurg Sci. 2003 Dec;47Zeme S, Zenga F.(4):189-93.

    PMID:14978472

    Extradural motor cortex stimulation for advanced Parkinson disease. Report of two cases.

    Canavero S, et al.

    J Neurosurg. 2002 Nov;97(5):1208-11.

    PMID:12450046


  • Are the claims properly placed in the context of the previous literature?

    largely. Their results are more favorable than most reported previously. The references are extensive but not all-encompassing


  • Do the results support the claims? If not, what other evidence is required?

    Yes. Study is sound, results are quite impressive, particularly compared to similar prior publications


  • If a protocol is provided, for example for a randomized controlled trial, are there any important deviations from it? If so, have the authors explained adequately why the deviations occurred?

    No


  • Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?

    Yes. Well designed study and well written manuscript.


  • Would any other experiments or additional information improve the paper? How much better would the paper be if this extra work was done, and how difficult would such work be to do, or to provide?

    As suggested in another review of this paper, a comparison of epidural motor cortex stimulation with DBS, or perhaps more appropriate would be comparison to subdural stimulation in terms of efficacy, stimulation parameters, complications, and IPG lifespan.


  • Is this paper outstanding in its discipline? (For example, would you like to see this work presented in a seminar at your hospital or university? Do you feel these results need to be incorporated in your next general lecture on the subject?) If yes, what makes it outstanding? If not, why not?

    Yes. dbs is well established, tms is gaining traction, but subdural or epidural motor cortex stimulation for advanced PD is not widely known as a treatment option and has lost some support even for its primary indication of intractable neuropathic pain.


  • Other Comments:

    NA

  • Competing interests:
    None
  • Invited by the author to review this article? :
    Yes
  • Have you previously published on this or a similar topic?:
    Yes
  • References:

    Dopaminergic neurons associate with blood vessels in neural transplants. Casper D, Finkelstein E, Goldstein IM, Palencia D, Yunger Y, Pidel A. Exp Neurol. 2003 Dec;184(2):785-93. PMID: 14769371

  • Experience and credentials in the specific area of science:

    I perform surgery for neuropathic pain using neurostimulators, surgery for epilepsy with neurostimulators, and treatment of dystonia. I do not have a significant movement disorders practice.

  • How to cite:  Goldstein I M.Epidural motor cortex stimulation for Parkinsons[Review of the article 'Efficacy and safety of unilateral chronic Epidural Motor Cortical Stimulation in neurosurgical treatment of Advanced Parkinson's Disease ' by Lavano A].WebmedCentral 2014;5(4):WMCRW003037
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Cortex or STN?
Posted by Dr. Jonathan Norton on 07 Mar 2014 05:18:51 PM GMT Reviewed by Author Invited Reviewers

  • What are the main claims of the paper and how important are they?

    In a subset of patients with PD who are not candidates for DBS epidural stimulation of the motor cortex offers good relief of symptoms. 


  • Are these claims novel? If not, please specify papers that weaken the claims to the originality of this one.

    epidural motor cortex stimulation is not novel in and of itself. The extent of this studay within PD is novel howevever. 


  • Are the claims properly placed in the context of the previous literature?

    There is more literature on motor cortex stimulation than cited by the authors, but most of the relevant PD literature is cited appropriately. 


  • Do the results support the claims? If not, what other evidence is required?

    These are still prelimianry results, but the evidence so far compelling. 


  • If a protocol is provided, for example for a randomized controlled trial, are there any important deviations from it? If so, have the authors explained adequately why the deviations occurred?

    N/A


  • Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?

    The methodology is adequate


  • Would any other experiments or additional information improve the paper? How much better would the paper be if this extra work was done, and how difficult would such work be to do, or to provide?

    Further experiments along the lines outlined by the authors, and importantly studies in other centres are required. 


  • Is this paper outstanding in its discipline? (For example, would you like to see this work presented in a seminar at your hospital or university? Do you feel these results need to be incorporated in your next general lecture on the subject?) If yes, what makes it outstanding? If not, why not?

    Not outstanding, but good nonetheless


  • Other Comments:

    No

  • Invited by the author to review this article? :
    Yes
  • Have you previously published on this or a similar topic?:
    No
  • References:
    None
  • Experience and credentials in the specific area of science:

    I am a neurophysiologist who performs DBS with a neurosurgeon.

  • How to cite:  Norton J .Cortex or STN?[Review of the article 'Efficacy and safety of unilateral chronic Epidural Motor Cortical Stimulation in neurosurgical treatment of Advanced Parkinson's Disease ' by Lavano A].WebmedCentral 2014;5(3):WMCRW003014
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  • What are the main claims of the paper and how important are they?

    Motor cortex stimulation is a proposal intervention in a subgroup of patients who can't be inviated to Deep Brain Stimulation. The suggestion is important because doesn't exclude a part of Parkinson's Disease patients


  • Are these claims novel? If not, please specify papers that weaken the claims to the originality of this one.

    The paper is a single-centre prospective observational study and the results suggest that extradural motor cortex stimulation ca modulate some parkinsonian cardinal symptoms in advanced parkinson's disease


  • Are the claims properly placed in the context of the previous literature?

    Undoubtedly


  • Do the results support the claims? If not, what other evidence is required?

    Yes


  • If a protocol is provided, for example for a randomized controlled trial, are there any important deviations from it? If so, have the authors explained adequately why the deviations occurred?

    NA


  • Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?

    Yes


  • Would any other experiments or additional information improve the paper? How much better would the paper be if this extra work was done, and how difficult would such work be to do, or to provide?

    This paper define a line of clinical research


  • Is this paper outstanding in its discipline? (For example, would you like to see this work presented in a seminar at your hospital or university? Do you feel these results need to be incorporated in your next general lecture on the subject?) If yes, what makes it outstanding? If not, why not?

    Yes because is an important augmentation in neuromudulation theraphy for patients with movements disorders


  • Other Comments:

    I thank the group of Catanzaro that is ever critical about clinical and research aspects on functional neurosurgery, this paper is the prove.

  • Invited by the author to review this article? :
    Yes
  • Have you previously published on this or a similar topic?:
    Yes
  • References:

    22 – IMPATTO DELLA NEUROMODULAZIONE CRONICA BILATERALE DEL NUCLEO SUBTALAMICO SULLA DISABILITA’ E SULLA QUALITA’ DELLA VITA NELLA MALATTIA DI PARKINSON: STUDIO CONTROLLATO CON FOLLOW UP A DUE ANNI. M.Capecci, D.Burini, V.G.Bombace, G.Riccardi, R.A.Ricciuti, M.Scerrati, L.Provinciali, M.G.Ceravolo. Eur Med Phys; 39 (S1 to issue n.3); pp. S235 – S238, 2003 23- CHRONIC BILATERAL SUBTHALAMIC NUCLEUS STIMULATION IN A PATIENT WITH HOMOZYGOUS DELETION IN THE PARKIN GENE. Capecci M, Passamonti L, Annesi F, Annesi G, Bellesi M, Cirò-Candiano C, Ricciuti RA et al Movement Disorders. Volume 19, Issue 12, Pages 1450 – 1452 – Jul 2004 24- STIMOLAZIONE CEREBRALE PROFONDA DEL NUCLEO SUBTALAMICO (DATI PRELIMINARI IN DUE CASI DI EPILESSIA FARMACORESISTENTE). A. Paggi, A. Ortenzi, N. Foschi, R. Ricciuti et Al. Bollettino Lega Italiana Epilessia 125/126 363-365, 2004 25- FUNCTIONAL IMPROVEMENT AFTER SUBTHALAMIC STIMULATION IN PARKINSON’S DISEASE: A CONTROLLED STUDY WITH 2 YEARS FOLLOW-UP. Capecci M, Ricciuti RA, Burini D, Bombace VG, Provinciali L, Iacoangeli M, Scerrati M and Ceravolo MG Journal of Neurology, Neurosurgery and Psychiatry, 76:769-774, 2005

  • Experience and credentials in the specific area of science:

    Im corcened in movement disorders surgical theraphy

  • How to cite:  Ricciuti R .Efficacy and safety of chronic Epidural Motor Cortex Stimulation in neurosurgicale treatment of advanced Parkinsons Disease[Review of the article 'Efficacy and safety of unilateral chronic Epidural Motor Cortical Stimulation in neurosurgical treatment of Advanced Parkinson's Disease ' by Lavano A].WebmedCentral 2014;5(2):WMCRW003009
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