case_images: PMC9376352_01
case_images: (A) Left hypointense lateral putaminal rim on T1-signal cranial magnetic resonance imaging (as indicated by the white arrow). (B)
  18F-fluorodeoxyglucose positron emission tomography scan revealed reduced in glucose metabolisms in the left putamen (as indicated by the white arrow). (C)
  18F-fluoropropyl-(+)-dihydrotetrabenazine positron emission tomography scan revealed hypometabolism in the left putamen (as indicated by the white arrow). (D) paddle-shaped electrode of spinal cord stimulation implanted into the epidural space at T10-T12 spinal cord segments. (E) 3D illustration for the localization of deep brain stimulation electrode contacts (model 3389, Medtronic) by the lead DBS software. Electrodes were implanted as follows: contacts 0, 1, and 2 were located inside the STN and contact 3 was located above the STN. (F) 2D illustration for the localization of active contacts by the lead DBS software.
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case_images: PMC9376352_01_fnins-16-929273-g001.jpg
case_images: F1
case_images: Parkinson's Disease Rating Scale Part III (MDS-UPDRS-III) motor score was 11% (91 vs. 81) without obvious on and off statements. Preoperative brain magnetic resonance imaging (MRI) revealed mild cerebral atrophy and a left lateral putaminal rim (Figure 1A). 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET) showed hypometabolism mainly in the left putamen, and 18F-fluoropropyl-dihydrotetrabenazine PET revealed that vesicular monoamine transporter type 2 (VMAT2) distribution was decreased mainly in the left putamen (Figures 1B,C). August 2020 after a full explanation of potential risks and benefits. A paddle-shaped SCS electrode (Adaptive Stim  39565; Medtronic, Minneapolis, MN) was implanted into the epidural space at thoracic levels ranging from the T10 to T12 spinal segments (Figure 1D). Intraoperative local field potential recordings showed elevated beta activity (frequency at 21-30 Hz) in the bilateral STN (Supplementary Figure 1). Figures 1E,F show the localization of electrode contacts and the active contacts by the lead DBS software.
case_images: The outcomes of MDS-UPDRS III and TUG in the medication-off state prior to surgery and at 0.5- (phase I trials), 4-, and 8-month postoperative. The stimulation test was performed separately, and the outcome was evaluated double-blindly at all follow-ups. (A-C) Outcome of total scores of MDS-UPDRS III (A), time (B), and steps (C) of the 7-m TUG by SCS stimulation (red lines), DBS stimulation (green lines), and DBS and SCS stimulation (blue lines). The combined stimulation of DBS and SCS showed a better improvement in MDS-UPDRS III and TUG than either SCS or DBS stimulation. (D-F) Subscores of MDS-UPDRS III, axial and posture subscores (D), upper-limb subscores (E), and lower-limb subscores (F) of MDS-UPDRS III. Axial and posture subscores: items 3.1, 3.2, 3.3, 3.9, 3.10, 3.11, 3.12, 3.13, and 3.14; upper-limb subscores: items 3.3, 3.4, 3.5, 3.6, 3.15, 3.16, and 3.17; lower-limb subscores: items 3.3, 3.7, 3.8, and 3.17. DBS stimulation and DBS and SCS stimulation did significantly improve the cardinal parkinsonian symptoms, and the improvement of upper limbs and axial symptoms mainly benefits from DBS stimulation, SCS stimulation alone slightly improves the cardinal parkinsonian symptoms, and the improvement was mainly embodied in lower limbs and axial symptom; most notably, the improvement of lower-limb symptoms was significantly enhanced by the combined stimulation. MDS-UPDRS III, Movement Disorder Society Sponsored Revision of the Unified Parkinson's Disease Rating Scale part III; TUG, Timed Up and Go test; SCS, spinal cord stimulation; DBS, deep brain stimulation.
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case_images: PMC9376352_03_fnins-16-929273-g002.jpg
case_images: F2
case_images: PMC9376352_02
case_images: PMC9376352_03
case_images: The outcomes of MDS-UPDRS III and TUG in the medication-off state prior to surgery and at 0.5- (phase I trials), 4-, and 8-month postoperative. The stimulation test was performed separately, and the outcome was evaluated double-blindly at all follow-ups. (A-C) Outcome of total scores of MDS-UPDRS III (A), time (B), and steps (C) of the 7-m TUG by SCS stimulation (red lines), DBS stimulation (green lines), and DBS and SCS stimulation (blue lines). The combined stimulation of DBS and SCS showed a better improvement in MDS-UPDRS III and TUG than either SCS or DBS stimulation. (D-F) Subscores of MDS-UPDRS III, axial and posture subscores (D), upper-limb subscores (E), and lower-limb subscores (F) of MDS-UPDRS III. Axial and posture subscores: items 3.1, 3.2, 3.3, 3.9, 3.10, 3.11, 3.12, 3.13, and 3.14; upper-limb subscores: items 3.3, 3.4, 3.5, 3.6, 3.15, 3.16, and 3.17; lower-limb subscores: items 3.3, 3.7, 3.8, and 3.17. DBS stimulation and DBS and SCS stimulation did significantly improve the cardinal parkinsonian symptoms, and the improvement of upper limbs and axial symptoms mainly benefits from DBS stimulation, SCS stimulation alone slightly improves the cardinal parkinsonian symptoms, and the improvement was mainly embodied in lower limbs and axial symptom; most notably, the improvement of lower-limb symptoms was significantly enhanced by the combined stimulation. MDS-UPDRS III, Movement Disorder Society Sponsored Revision of the Unified Parkinson's Disease Rating Scale part III; TUG, Timed Up and Go test; SCS, spinal cord stimulation; DBS, deep brain stimulation.
case_images: fnins-16-929273-g002.jpg
case_images: PMC9376352_03_fnins-16-929273-g002.jpg
case_images: F2