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Spinal cord stimulation for gait impairment in spinocerebellar ataxia 7

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Abstract

The aim of this study is to report on the clinical efficacy of epidural thoracic spinal cord stimulation on gait and balance in a 39-year-old man with genetically confirmed spinocerebellar ataxia 7. A RESUME Medtronic electrode was placed at the epidural T11 level. Spatiotemporal gait assessment using an electronic walkway and static posturography were obtained and analyzed in a blinded manner with and without stimulation. The Tinetti Mobility Test was also performed in the two conditions. At 11 months after surgery, there was a 3-point improvement in the Tinetti Mobility Test in the on stimulation condition, although there was no statistically significant difference in spatiotemporal gait parameters. Static posturography did not demonstrate a significant improvement in stability measures between the two conditions in a stochastic way. Thoracic epidural spinal cord stimulation had a mild but clinically meaningful beneficial effect in improving gait and balance in a patient with SCA-7. The underlying pathophysiologic mechanisms remain to be elucidated. Further experience with spinal cord stimulation in refractory gait disorders is warranted.

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Acknowledgments

The authors would like to thank Brent Geobey and Alex Valencia Mizrachi for their excellent technical support and support of the patient and his family. Patient consent obtained. Data sharing statement Dr. Moro has full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Conflicts of interest

Dr. Moro has received honoraria from Medtronic for lecturing. Dr. Lozano is a consultant for Medtonic, St Jude and Boston Scientific.

Ethical standard

All ethical standards for the conduct of clinical research met.

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Authors and Affiliations

  1. Movement Disorders Centre, Toronto Western Hospital, 399 Bathurst Str, Toronto, ON, M5T 2S8, Canada

    Christos Sidiropoulos, Tiago Mestre, Yu-Yan Poon, Melanie Fallis, Binit B. Shah & Elena Moro

  2. Parkinson’s Disease and Movement Disorders Program, Henry Ford Hospital, 6777 West Maple Road, West Bloomfield, Detroit, MI, 48322, USA

    Christos Sidiropoulos

  3. Lyndhurst Centre, Toronto Rehabilitation Institute, University Health Network, 520 Sutherland Drive, Toronto, ON, M4G 3V9, Canada

    Kei Masani, Matija Milosevic & Milos R. Popovic

  4. Institute of Biomaterials and Biomedical Engineering, University of Toronto, 164 College Street, Toronto, ON, M5S 3G9, Canada

    Kei Masani, Matija Milosevic & Milos R. Popovic

  5. Department of Neurology, University of Virginia, Box 800394, Charlottesville, VA, USA

    Binit B. Shah

  6. Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto Western Hospital, 399 Bathurst St, Toronto, ON, M5T 2S8, Canada

    Suneil K. Kalia & Andres M. Lozano

  7. Movement Disorders Unit, Department of Psychiatry and Neurology, University Hospital Center (CHU) of Grenoble, BP 217, 38043, Grenoble CEDEX 09, France

    Elena Moro

Authors
  1. Christos Sidiropoulos
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  2. Kei Masani
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  3. Tiago Mestre
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  4. Matija Milosevic
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  5. Yu-Yan Poon
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  6. Melanie Fallis
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  7. Binit B. Shah
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  8. Suneil K. Kalia
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  9. Milos R. Popovic
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  10. Andres M. Lozano
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  11. Elena Moro
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Corresponding author

Correspondence to Elena Moro.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Video Segment 1 ON stimulation condition, December 2012 (MP4 8551 kb)

415_2013_7236_MOESM2_ESM.mp4

Video Segment 2 OFF stimulation condition, December 2012, with increased freezing and instability upon turning (MP4 8152 kb)

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Sidiropoulos, C., Masani, K., Mestre, T. et al. Spinal cord stimulation for gait impairment in spinocerebellar ataxia 7. J Neurol 261, 570–574 (2014). https://doi.org/10.1007/s00415-013-7236-0

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  • DOI: https://doi.org/10.1007/s00415-013-7236-0

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