Spinal cord stimulation (SCS) in spastic hemiparesis.

Thirteen patients with post-stroke spastic hemiparesis underwent a percutaneous test trial of spinal cord stimulation (SCS) in order to modify their motor disturbances. Clinical evaluation based on Albert's motor scale and neurophysiological evaluation consisting of surface EMG during voluntary, involuntary, and reflex motor activity were performed before and during SCS. At the end of the test period, eight patients showed a significant improvement in their motor performance. The EMG analysis confirmed the clinical data. SCS was followed by a reduction or disappearance of synergic coactivation with better agonist-antagonist coordination, a decrease of clonus both in duration and spreading, and better endurance. The effect on motor control did not increase with time after the first month of SCS, but was long lasting (mean follow-up: 2 years). There was a correlation between sensory deficit and motor outcome suggesting that the enhancement of sensory input put into play by SCS and the consequent development of new sensory-motor integration might be responsible for the improvement in motor performance.