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Final Program


Final Congress Guide

Therapeutics

1000 Section - Electrical Spinal Cord Stimulation for Orthostatic Hypotension in Parkinson's Disease

Tuesday, May 19, 2026
6:00 PM - 7:30 PM PT

    Presenting Author/Autor expositor(s)

  • XZ

    XUE ZHU, MD

    Postdoc
    ICORD
    Vancouver, British Columbia, Canada

    • Co-Author/Coautor(s)

  • JL

    Jun Liu, MD

    Professor
    Department of Neurology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine
    Shanghai, Shanghai, China (People's Republic)

    • Corresponding Author/Autor a quien dirigir la corr(s)

  • AK

    Andrei Krassioukov, MD

    Professor
    ICORD
    Vancouver, British Columbia, Canada

Case Diagnosis:

Orthostatic Hypotension (OH) is a critical, disabling, and life-threatening non-motor symptom in Parkinson's disease (PD), affecting up to 70% of patients. OH remains largely refractory to conventional treatments; dopaminergic therapies often worsen it, and existing anti-OH drugs risk supine hypertension, leaving a substantial patient subset profoundly disabled by syncope and cognitive decline. We report the first successful application of epidural spinal cord stimulation (eSCS) for refractory PD-OH in a 69-year-old male who was bedridden for three years despite maximum pharmacological efforts.

Case Description:

A paddle lead was implanted at the T10-T11 spinal level (cathode 0/anode 5, 150us, 65 Hz, 5-6V). Assessment via 70° Tilt-Table Test (TTT) at baseline showed profound OH, severe cerebral hypoperfusion, and 20 hours of daily bed confinement. Remarkably, within 3 days of eSCS activation, orthostatic symptoms completely resolved. At 3 months, eSCS-ON led to superior hemodynamic stabilization, marked by complete syncope resolution and a drastic reduction in the orthostatic systolic blood pressure drop during TTT (18.6mmHg ON vs. 64.2mmHg OFF), paralleled by augmented cerebral perfusion. 

Discussions:

Crucially, this autonomic stability drove profound functional recovery: the patient progressed from three years of bed confinement to autonomous ambulation, with walking/standing time increasing from zero to 4 hours daily (150.4% surge in 6-minute walk test mobility), while remaining off anti-OH/PD medications.

Conclusions:

This case demonstrates that eSCS, by targeting thoracic sympathetic circuits, is a potentially life-changing therapeutic avenue for PD patients whose primary disability is dictated by dysautonomia.