Motor cortical stimulation for XXXX in @entity9576 .

@entity1 @entity410 @entity162 @entity304 @entity9576 @entity2845 @entity191
BACKGROUND: Functional neuroimaging studies have demonstrated disturbances in the activity of premotor and motor cortices in @entity191 and in animal models of @entity304 that improve in response to effective basal ganglia surgical therapy. Techniques that directly alter the function of these cortical areas, such as transcranial magnetic stimulation, have been applied in @entity1 with @entity191 , with transient improvement in their @entity2845 and gait dysfunction. Recently, a @entity1 with @entity191 was claimed to have obtained a marked bilateral clinical benefit from extradural unilateral motor cortical stimulation. We hypothesized that direct cortical stimulation could alleviate the disability of the treatment-refractory @entity304 commonly present in @entity9576 . OBJECTIVE: To evaluate the efficacy of motor cortical stimulation in @entity1 with refractory @entity304 due to @entity9576 ( @entity9576 ). METHODS: Five @entity1 with a diagnosis of @entity9576 with predominant @entity304 underwent surgery for subdural motor cortical stimulation. MAIN OUTCOME MEASURES: Changes in activities of daily living and motor subscores on the Unified @entity191 Rating Scale 12 hours after medication withdrawal. Scores at baseline and 3 to 6 months following surgery were compared. RESULTS: All @entity1 had a decline in motor scores at the follow-up evaluations despite the application of a variety of adjustments. The activities of daily living score mildly worsened by 9.7% (95% confidence interval, 32.3 to-13.0; P =.37) and the motor score worsened by 25.6% (95% confidence interval, 58.7 to -7.5; P =.06). Despite objective worsening over time and no deterioration when stimulation was immediately turned off, 3 @entity1 still claimed subjective benefit and requested continued stimulation. No @entity1 suffered adverse effects from the surgery or long-term stimulation, although 1 @entity1 had a stimulation-induced @entity410 during the initial programming. The range of settings for 4 @entity1 with @entity162 and 1 @entity1 with monopolar configuration were as follows: amplitude, 3 to 3.6 V; pulse width, 40 to 90 milliseconds; and pulse rate, 145 to 185 Hz. CONCLUSIONS: Our data suggest that motor cortical stimulation using these parameters fails to improve the motor disability in @entity9576 . Worsening of motor scores was likely a function of disease progression.
