Effects of deep brain stimulation of the subthalamic nucleus on freezing of gait in Parkinson's disease: a prospective controlled study

Abstract

In contrast to continued BMT, STN-DBS reduced FOG occurrence and severity at 6 months postsurgery with largely sustained effects at 12 months follow-up. Longer follow-up periods are needed to test whether FOG improvements after STN-DBS persist with disease progression.

Neuromuscular correlates of subthalamic stimulation and upper limb freezing in Parkinson’s disease

“…Previous functional imaging research pointed to a specific role of the subthalamic nucleus in gait freezers (Fling et al, 2013;Shine et al, 2013a;Vercruysse et al, 2013). Similar evidence came from clinical studies that pointed to basal ganglia outputs in terms of STN (Vercruysse et al, 2014) and the substantia nigra pars reticulata (Weiss et al, 2013) as important modulators of gait freezing. Moreover, cortical processing as well as subcortico-cortical interactions seem to be relevant.…”

“…We introduced dual task interference, in order to reliably obtain freezing episodes under research laboratory conditions (Camicioli et al, 1998;O'Shea et al, 2002;Spildooren et al, 2010). StimOn was considered as therapeutic condition, as we aimed to capture ULF resistant to subthalamic stimulation therapy as a widely recognized limitation of PD state-of-the-art therapy in advanced disease stages (Krack et al, 2003;Vercruysse et al, 2014;Weiss et al, 2013). We only analyzed the ULF episodes during StimOn interference in order to study freezing resistant to subthalamic stimulation.…”

“…However, freezing shows a less favorable therapeutic response (Vercruysse et al, 2014;Weiss et al, 2013) and a closer pathophysiological understanding is highly warranted. Functional imaging pointed to both cortical and subcortical network abnormalities in freezers, and implicated the subthalamic nucleus, as well as the mesencephalic locomotor region and higher-order cortical areas in freezing pathophysiology (Herman et al, 2013;Shine et al, 2013b).…”

Cortical correlates of susceptibility to upper limb freezing in Parkinson’s disease

“…Current standard treatments such as L-Dopa and deep brain stimulation of the subthalamic nucleus (STN-DBS) often fail to control freezing behavior in the advanced disease stage (Vercruysse et al , 2014, Weiss et al , 2013. This may mirror the incomplete understanding of the complex pathophysiology behind freezing behavior.…”

Treatments for Neurological Gait and Balance Disturbance: The Use of Noninvasive Electrical Brain Stimulation

“…Deep brain stimulation (DBS) has revolutionized the management of dopaminergic motor features in many patients with severe Parkinson's disease, and whilst there is some evidence in support of DBS in the treatment of gait disorders in these patients [17], its effect on the nondopaminergic motor features of Parkinson's disease, such as gait and balance, has been variable. Thus, one study showed that approximately 50% of freezers convert to nonfreezers after subthalamic nucleus DBS [18], although freezing of gait has also been shown to worsen after bilateral DBS [19]. In patients with resistant gait disturbance stimulation of the substantia nigra pars reticulata appears to improve axial motor features [20], including freezing of gait [21].…”