Chronic self-stimulation of the dentate nucleus for the relief of spasticity.

Abstract

It has been assumed but not yet proved that cerebellar cortical stimulation activates the Purkinje cells, with subsequent inhibition of the deep cerebellar nuclei. However, the relatively crude, widespread excitation induced by several surface electrode arrays and the parameters of stimulation currently used, may produce other effects than selective activation of only one specific cellular type which, furthermore, seems to be rarely present in these particular patients, as demonstrated by biopsy studies prior to electrode placement. The dentate nucleus was chronically implanted with a stimulating system in a patient with spasticity due to cerebral palsy. Chronic self-stimulation induced a significant improvement in motor function, with relief of spasticity and improvement in speech, posture, balance and gait. Electrophysiological studies demonstrated a decrease in the amplitude of V1 and V2 responses and in the H/M and T/M ratios, an increase in the silent period, and marked effects in the H reflex recovery curve, as well as diminished contralateral cortical somato-sensory evoked potentials. This result seems to indicate that the clinical effects of cerebellar cortical stimulation are not due to prosthetically induced inhibition of the dentate nucleus.