Subthalamic nucleus deep brain stimulation reduces freezing of gait subtypes and patterns in Parkinson's disease

Abstract

Freezing of gait (FOG) is a specific gait disorder in Parkinson's Disease (PD). FOG occurs mainly in the medication-off state and usually improves with dopaminergic medication. FOG episodes can be clinically grouped into three patterns (small steps forward, trembling in place, complete akinesia) and five provoking subtypes (starting to walk hesitation, moving in tight quarters hesitation, reaching destination hesitation, turning hesitation, and walking in open space hesitation) [1]. FOG is a debilitating symptom, limiting activities of daily living, leading to falls or fall-related injuries, and diminishing quality of life [2]. The effect of deep brain stimulation of the subthalamic nucleus (STN-DBS) on freezing of gait (FOG) remains under debate since the prior results were conflicting. Whereas some studies [3,4] found an overall reduction of FOG under STN-DBS (although in most cases not to the same extent as non-axial symptoms), others reported no effect or even a deterioration of FOG [5e7]. The aim of this study was to evaluate the effect of STN-DBS on FOG with a special focus on the different FOG subtypes and patterns, as observed during a FOG provoking walking test performed before and at three follow ups after implantation. The VANTAGE study [8] e a multicenter, prospective, openlabel, non-randomized trial e assessed the effect of an implantable DBS system (Vercise™, Boston Scientific, Valencia, CA, USA) for bilateral stimulation of the STN in subjects with moderate to severe PD. In this preplanned sub-study, FOG was evaluated both subjectively (FOG questionnaire (FOGQ), the PDQ-39 mobility items, and FOG-specific items of the UPDRS II (items 13 [falls] and 14 [freezing])) and objectively with a standardized walking test provoking FOG (adapted from Ref. [1]). It was performed at baseline and at weeks 12, 26, and 52 postoperatively in the medication-on and-off state. STN-DBS was activated at all follow ups. The walking test was videotaped and made available for offline analysis by an independent and fully blinded rater (CB), who was unaware of the

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

“…In this study, STN‐DBS significantly reduced FOG at 6 and 12 months, but 45% of the baseline freezers remained freezers in the DBS group and 2 patients developed de novo FOG in the DBS group. A secondary analysis of a recent STN‐DBS trial could demonstrate that STN‐DBS is effective for all FOG subtypes and patterns in a gait test known to provoke FOG‐episodes. Many of the existing controlled, prospective DBS studies did not provide their data on FOG separately .…”

Spinal Cord Stimulation for Freezing of Gait: From Bench to Bedside

“…Most PD symptoms respond well to medication alone and additional deep brain stimulation (DBS) (96). Even FoG may improve chronically with DBS when this symptom responds acutely during the levodopa challenge test (97). So, FoG subtype unresponsive to medication or DBS may in the future be one of the indications to SCS in PD.…”

The Therapeutic Effect of Nordic Walking on Freezing of Gait in Parkinson’s Disease: A Pilot Study

“…As it was said before, we know too little about pathophysiology of FoG to speculate whether our results should be interpreted as confirming the existence of separate mechanisms responsible for FoG subtypes. It should be noted, however, that the recently published study revealed the same efficacy of STN-DBS in all types of FOG provoked by different circumstances [53].…”