Deep Brain Stimulation for Freezing of Gait in Parkinson's Disease With Early Motor Complications

Abstract

Background Effects of DBS on freezing of gait and other axial signs in PD patients are unclear. Objective Secondary analysis to assess whether DBS affects these symptoms within a large randomized controlled trial comparing DBS of the STN combined with best medical treatment and best medical treatment alone in patients with early motor complications (EARLYSTIM‐trial). Methods One hundred twenty‐four patients were randomized in the stimulation group and 127 patients in the best medical treatment group. Presence of freezing of gait was assessed in the worst condition based on item‐14 of the UPDRS‐II at baseline and follow‐up. The posture, instability, and gait‐difficulty subscore of the UPDRS‐III, and a gait test including quantification of freezing of gait and number of steps, were performed in both medication‐off and medication‐on conditions. Results Fifty‐two percent in both groups had freezing of gait at baseline based on UPDRS‐II. This proportion decreased in the stimulation group to 34%, but did not change in the best medical treatment group at 24 months (P = 0.018). The steps needed to complete the gait test decreased in the stimulation group and was superior to the best medical treatment group (P = 0.016). The axial signs improved in the stimulation group compared to the best medical treatment group (P < 0.01) in both medication‐off and medication‐on conditions. Conclusions Within the first 2 years of DBS, freezing of gait and other axial signs improved in the medication‐off condition compared to best medical treatment in these patients. © 2019 International Parkinson and Movement Disorder Society

Die Geschichte des ‚Freezing-of-gait‘ beim Parkinson-Syndrom – vom Phänomen zum Symptom

“…Aufgrund der limitierten medikamentösen Therapieoptionen und des Zusammenhangs mit der gestörten Vernetzung der motorischen Kontrollzentren im Gehirn [54] könnte die Tiefe Hirnstimulation (DBS) eine weitere Therapieoption sein. Die subthalamische (STN) Stimulation kann in der Tat zu einer Verbesserung des FOG führen [55,56]. Allerdings konnte diese Befund nicht von allen Autoren bestätigt werden, sodass verschiedene Variablen für die Therapie des Freezing mittels STN-DBS diskutiert wurden.…”

“…Dieses Ergebnis der ersten randomisierten und kontrollierten Studie wird gerade in einer multizentrischen Studie im Parallel-Gruppen-Design validiert. Auch die Subtypen des FOG, insbesondere die Motor-Fluktuations-assoziierten FOG Formen, lassen sich durch DBS verbessern [55,56]. Es ist jedoch noch offen, ob die berichteten positiven Effekte der DBS auf das FOG in Analogie zur Steigerung des dopaminergen Tonus stehen oder ob ein direkter Einfluss des Stimulationsortes auf die fehlerhafte Konnektivität für die FOG-Besserung verantwortlich ist.…”

Entraining Stepping Movements of Parkinson's Patients to Alternating Subthalamic Nucleus Deep Brain Stimulation

“…However, the impact of STN DBS on gait control is less consistent and can even result in deterioration of gait (Barbe et al, 2020;Collomb-Clerc & Welter, 2015). Conventional highfrequency DBS is provided continuously and is thought to attenuate beta activity (Kühn et al, 2008).…”

Intestinal Levodopa/Carbidopa Infusion as a Therapeutic Option for Unresponsive Freezing of Gait after Deep Brain Stimulation in Parkinson’s Disease

“…Treatment of FOG is a clinical challenge, and different strategies such as modification of levodopa dosage, adding catechol-O-methyltransferase inhibitors or amantadine, deep brain stimulation (DBS), apomorphine, metilphenidate, and even electroconvulsive therapy have been used to improve this phenomenon with varying outcomes [3]. DBS has shown significant improvement in gait and FOG [4] but in some PD patients can aggravate or even induce FOG and postural instability [5][6][7]. Previous case reports [8,9] and two recent studies [10,11] have found that FOG resistant to conventional oral therapy may benefit from levodopa/carbidopa intestinal gel (LCIG) infusion.…”