Motor cortex stimulation in Parkinson’s disease

Motor fluctuations, which are not controlled by pharmacological treatment, are often encountered in long-term Parkinson’s disease (PD). Deep brain stimulation is considered a valid alternative to pharmacological treatment in patients affected by PD, but it is most effective in patients aged less than 70 years. Cortical dysfunction significantly contributes to the pathogenesis of motor symptoms in different movement disorders, included PD. For this reason, therapeutic strategies based on cortical stimulation have been proposed. Motor cortex stimulation (MCS) was introduced in 1991 to relieve poststroke refractory thalamic pain. In 2000, the improvement of symptoms in a single case of advanced PD was reported after chronic epidural motor cortex stimulation (MCS). Since then, many other authors reported similar results. Currently, this neurosurgical neuromodulatory therapy represents an alternative therapy for PD with low morbidity and mortality. Moreover, the relevant noninvasive surgical technique makes this treatment particularly indicated in geriatric patients. Here, we summarize the findings of several unresolved issues concerning the use of MCS as a possible treatment for PD.