Thoracic Epidural Spinal Stimulation for Orthostatic Hypotension in Multiple-System Atrophy

A case report on the use of an implantable system

The parkinsonism syndrome of multiple-system atrophy (MSA) is notoriously hard to treat. The extensive involvement of the autonomic nervous system in these cases frequently results in severe orthostatic hypotension and syncope. Investigators have now piloted the therapeutic use of a system that delivers epidural electrical stimulation over the thoracic spinal cord region, using an implantable pulse generator and an accelerometer to detect changes in body position.

The investigators report on the use of this approach in a 48-year-old woman with the parkinsonian subtype of MSA. She reported being limited to walking 5 meters or less over an 18-month period because of syncopal or pre-syncopal symptoms. The system was implanted surgically, and an…

Reviewing Author

Michael S. Okun, MD

Disclosures

Consultant/Advisory BoardParkinson’s Foundation; Tourette Association of America

Speaker’s BureauMedscape/WebMD CME, Movement Disorders Society CME, American Academy of Neurology CME

RoyaltiesBooks4Patients; Demos; Cambridge; Taylor and Francis; Robert Rose; Public Affairs

Grant/Research SupportNational Institutes of Health; Parkinson’s Foundation; Tourette Association of America; University of Florida Foundation

Editorial BoardsTremor and Other Hyperkinetic Movements; JAMA Neurology

Leadership Positions in Professional SocietiesParkinson’s Foundation (Medical Advisor)