In a recent issue of the ARCHIVES, Kleiner-Fisman et al1 reported the use of motor cortical stimulation for multiple system atrophy (MSA)–related parkinsonism. A few comments are in order. We introduced extradural motor cortical stimulation for Parkinson disease (PD) in 1998 and have since reported 3 cases.2-4 We observed that low-frequency but not high-frequency extradural motor cortical stimulation relieved all signs of PD in a range comparable with deep brain stimulation (DBS). Our results have been confirmed by other European groups (unpublished observations). We also described a now deceased patient with MSA and parkinsonian symptoms.2