Objective: Conduct a scoping review to examine the effects of epidural spinal cord stimulation on multiple clinical symptoms of movement disorders.

Background: Prior research has demonstrated positive, but mixed, clinical and physiologic effects of spinal cord stimulation on various movement disorder symptoms. In part this may be due to the variability in disease and patient presentation, symptoms being measured as well as the differences in therapy application.

Method: A scoping review was conducted via a search protocol utilizing relevant literature databases including Pubmed, EMBASE, and Google Scholar. Back searches through cited references were also utilized. Literature that included original, human clinical and physiologic outcomes data focusing on symptoms in the following conditions/symptoms were eligible for analysis: Parkinson’s disease, freezing of gait, tremor, dystonia and spasticity. In total, 1175 hits were obtained from preliminary searches. From this original list, 90 literature assets were selected for original human outcomes data focusing on lead placements, stimulation parameters and symptom improvements among other variables.

Results: Basic anatomic concordance in lead and symptom location were expectedly found. While examples of several different stimulation paradigms (eg low-moderate frequency tonic, high frequency tonic, burst, various electrode configurations, etc) were evident, trends across studies were promising but less consistent. Effective clinical and physiologic effects across several different motor symptoms, with presumably different underlying neurophysiology, were also demonstrated including a hypothesized reduction in upper and lower motor neuron excitability, reflex control of skeletal muscles and recurrent motor patterns. Mechanisms of effects were hypothesized to be both spinal and supraspinal in nature, depending upon the motor symptoms through simple spinal reflex arcs or more complex central desynchronization.

Conclusion: Spinal cord stimulation can alter physiology in multiple ways that positively impact motor symptoms present in several different pathologies and conditions. Application of patterned electricity to the dorsal columns, or more lateral epidural areas, can have multiple effects on the underlying neurophysiology impacting skeletal motor control.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/a-scoping-review-of-epidural-spinal-cord-stimulation-in-the-treatment-of-multiple-movement-disorder-symptoms/