Abstract
Dorsal column stimulation (DCS) was tried on post-apoplectic spastic hemiplegia for reduction of spasticity.
Three patients with spastic hemiplegia due to apoplexia were selected for DCS. Electrodes of Medtronic's SCS system were placed at the dorsal part of the lower cervical or upper thoracic spinal cord extradurally. Stimulation with waves of 35-100 Hz and 1.0-1.5V was continued for 12-14 hours during the day everyday.
Reduction of the spasticity was observed 3 to 9 days after the stimulation. In Case 1, a 74-yearold male, spasticity of the lower extremity was reduced and his gait improved remarkably. In Case 2, a 47-year-old male, spasticity of the upper extremity was reduced slightly and his gait also improved. In Case 3, a 47-year-old male, spasticity of the upper extremity was reduced at an early period after the stimulation. However, walking speed and motor function of the extremities temporarily dropped two weeks after the stimulation. Electrophysiological evaluation of the spasticity with Hreflex showed remarkable improvement in all three patients.
Reduction mechanism of the spasticity has not been clarified yet. The direct or indirect effect to the reticulo-spinal tract is supposed to play a role. The DCS does not promote the function of the injured pyramidal tract itself, but it may help the physical treatment for post-apoplectic hemiplegia by reducing the spasticity which interferes with the recovery from paretic motor disorders.
