High-Frequency Spinal Cord Stimulation (Hf-Scs) Improves Motor As Well As Cognitive Performances In A Case Of Hereditary Spastic Paraplegia

We report a case of complicated hereditary spastic paraplegia treated with spinal cord stimulation. A 40 year-old man with slowly progressive spastic paraparesis,moderate cognitive deficit,was submitted to the implant of a cervical epidural electrode for the neuromodulation of spasticity.After trial with 80Hz stimulation,patient referred some motor improvement,but unpleasant paraesthesiae.We tested 10000Hz stimulation that does not induce paraesthesiae.Before and after15days:neurological status (Ashworth scale,Albert scale,VAS,Hamilton depression scale),gait analysis,quality of life (SF-36),neuropsychological evaluation,brain single photon emission computer tomography(SPECT)with HMPAO to assess regional cerebral perfusion. The patient during HF-SCS referred a better endurance, walk and could lay down and stand up faster, with more fluent language,and a better vescico-sphincterial control.Ashworth scale decreased from 20 to 17,Albert scale improved from 143 to 149.Increase of gait speed by 26%, increased step length (by 40.8%),decreased double support(by 43.5%).Kinematic analysis showed hip and knee decreased flexion.The Hamilton scale showed no signs of depression.The SF-36 improved,particularly the Physical Health Index (from 33 to 43).The neuropsychological studies showed an improvement of dysarthria,marked improvement in the test of word reading,in the visual comprehension of names,denomination of names,constructive praxia tests along with a mild improvement in MMSE and short term memory.The brain SPECT during SCS showed an increased perfusion in the right frontal and temporal cortex and in the left fronto-temporal cortex. The patient was submitted to chronic stimulation.The motor and cognitive improvement was confirmed at the 12 months follow up visit. HF-SCS improves motor as well as language and cognitive performances without inducing disturbing paraesthesiae in a case of complicated hereditary spastic paraplegia.