Epidural spinal cord stimulation in hereditary spastic paraplegia: preliminary results

Hereditary spastic paraplegia is a diverse group of inherited neurodegenerative diseases characterized by spasticity and weakness in the lower extremities. Treatment is comprehensive and includes pharmacotherapy and physical therapy. If these approaches are ineffective, neurosurgical methods such as rhizotomy or intrathecal baclofen therapy are applied. Epidural spinal cord stimulation is still poorly studied. OBJECTIVE: To evaluate safety and efficacy of epidural spinal cord stimulation in patients with hereditary spastic paraplegia. MATERIAL AND METHODS: The study (2015-2024) included patients with hereditary spastic paraplegia refractory to conservative treatment. After test stimulation, permanent spinal stimulation systems (classic generator-based and wireless external) were implanted in 18 patients. The modified Ashworth scale, the Spastic Paraplegia Rating Scale (SPRS), the Timed Up and Go Test (TUG), the Ten-Meters Walk Test (10MWT), and the SF-36 questionnaire were used to assess neurological status preoperatively and six months after surgery. The study was approved by local ethics committee. RESULTS: Implantation of permanent stimulation system (electrodes at the level of Th10-Th12) was performed in 18 patients (13 men, 5 women). Of these, 7 patients received wireless systems with external energy source, while 11 ones received classic generator systems. Six months after the intervention, we observed improvements in the following parameters compared to pre-implantation state: MAS score from 3 to 1.5-1 (18 patients); TUG test by 11.2-19.7% (17 patients); 10MWT test by 12.6-20.5% (17 patients); SPRS score by 27.9% (17 patients); SF-36 score 30-66% (16 patients). CONCLUSION: Epidural spinal cord stimulation may be considered for hereditary spastic paraplegia, but further research is needed to clarify its role in symptomatic treatment of spastic paraplegia.