Currently there is a renewal of interest to use spinal cord stimulation (SCS) as a treatment for improving motor control and reducing spasticity in central motor pathway disorder. Here, we report documented positive long lasting effect both on spasticity and on motor control, in a 26-year-old man with Hereditary Spastic Paraparesis with severe, widespread lower limb spasticity and limitation of mobility.

SCS material consisted of 4 electrodes (MEDTRONIC) on the posterior epidural space at T6 level (entry zone L1). The stimulation parameters were initially set as follows: amplitude 4.0–7V, rate 70–100Hz, pulse width 210μsec. The SCS Balance control was assessed by timed right and left stance. Gait control was assessed by the timed 10-meter walk test at preferred and maximal speed. Measurements were performed stimulation on and off, in many sessions 6 months apart. Data were analysed by the Mann–Whitney U test, with P<0.05 considered significant.

The stimulation decreased spasticity, especially for proximal muscles. Stimulation on, performance at all tasks was improved. In the condition stimulation off, the patient was more performing than 6 months before, possibly due to long-lasting effects of the stimulation that progressively increased with time. The gains obtained after six months of intermittent stimulation were substantial: 4.7% for maximal walking speed, 11.2% for preferred walking speed, 85% for right stance ability and 55% for left stance ability. The positive effect lasted 4.5 years.

In the light of the new technological developments both for electrodes and the control of stimulation parameters, together with a better understanding of the mechanisms underlying the effect of the SCS for improving motor control and reducing spasticity, our results could be useful to enhance the treatment of future patients.