Objective: The objective of this case report is to highlight the effect of a new technology, Evoked Compound Action Potential (ECAP) controlled closed-loop spinal cord stimulation (SCS), on neuropathic pain and motor control in a Parkinson’s Disease patient suffering from radicular pain

Background: SCS is a commonly used treatment of last resort, to manage refractory neuropathic pain. The most recent advance in the field of SCS is the introduction of ECAP sensing and automated amplitude modulation by using the ECAP as a control variable in a closed-loop system. Several case reports, and prospective case series,  investigated the use of SCS to improve function in patients with Parkinson’s Disease (PD). Mostly these reports have focused on changes to Freezing of Gate (FoG) symptoms. Herein, we present a case report of improved motor function following the application of ECAP-controlled closed-loop SCS for the management of radicular pain in a patient with concomitant PD

Method: A retrospective case report of a single patient’s experience of improvement in both pain and PD symptoms following the application of ECAP-controlled closed-loop SCS. In an attempt to differentiate the effect of SCS on gait improvements from the pain effect, walking tasks were recorded with stimulation turned on and off

Results: Two, 12-contact SCS leads were implanted in the posterior epidural space spanning the lower thoracic spinal cord (T8-T11). ECAP-controlled closed-loop stimulation was delivered to provide a stimulation-induced sensation (paresthesia) in both legs, predominantly covering the most painful limb. 3-months post-implantation leg pain intensity was reduced from 9/10 to 0/10 (verbal rating scale 0-10). Our patient, who was wheelchair-bound prior to implantation of the SCS system, can now walk without assistance. Acute deactivation of the SCS system caused a reduction in muscle strength and walking speed while the radicular remained still suppressed*

*If accepted for presentation stimulation on/off videos will be shown

Conclusion: This anecdotal report of motor improvements following low thoracic ECAP-controlled closed-loop SCS provides a further small signal that SCS may offer some clinical utility for the management of motor symptoms associated with PD. A prospective study in PD patients in whom pain is not a significant co-morbidity would be a useful next step

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MDS Abstracts - https://www.mdsabstracts.org/abstract/ecap-controlled-closed-loop-scs-alleviates-neuropathic-pain-and-improves-motor-function-in-a-patient-suffering-from-parkinsons-disease-and-radicular-pain/