Troubleshooting Gait Problems in Parkinson’s Disease Patients with Subthalamic Nucleus Deep Brain Stimulation

Abstract

Subthalamic nucleus deep brain stimulation (STN DBS) is an established therapy for a subset of patients with Parkinson’s disease, and the adjustment of DBS parameters is typically guided by the patients’ rigidity and tremor. Although these cardinal symptoms remain relatively stable over time, progressive worsening of axial symptoms compromise motor function and quality of life. Because many patients report improvements in their global mobility after gait improvement, we have been adjusting DBS parameters during the long-term after surgery based on gait analysis. Here, we describe a practical strategy for troubleshooting gait problems in PD DBS patients by revising stimulation parameters through “hands-on” programming, which can be a useful alternative approach for improving patients’ outcomes after STN DBS.

Deep brain stimulation in Parkinson’s disease: state of the art and future perspectives

“…In PD, the SNr is abnormally overactivated, which inhibits the locomotor region and contributes to gait problems observed with disease progression 63 . Double stimulation of the SNr and the STN was superior in controlling FOG compared to STN stimulation alone 34 . Another recent study showed that high-frequency stimulation of the SNr but not of the STN improved the anticipatory postural adjustments in PD, confirmed by two other trials 63 .…”

“…Other programming strategies to improve gait in PD can be tried, particularly when the gait parameters are asymmetric or when freezing of gait (FOG) is clearly driven by one body side. In these conditions, improvements can be obtained when current is reduced contralateral to the side of larger step length 34 , or when LFS is used contralateral to the side in which FOG most usually occur 34 . The combined stimulation of STN and substantia nigra (SN) can also be tried to improve resistant axial motor impairment in PD patients 34 .…”

“…In these conditions, improvements can be obtained when current is reduced contralateral to the side of larger step length 34 , or when LFS is used contralateral to the side in which FOG most usually occur 34 . The combined stimulation of STN and substantia nigra (SN) can also be tried to improve resistant axial motor impairment in PD patients 34 .…”

Editorial: Insights into the use of deep brain stimulation as a treatment for Parkinson's disease and related conditions

“…Liu et al 's research found that individual substantia nigra (SN) susceptibility features, derived from radiomics, can predict global motor and rigidity outcomes post-STN-DBS in PD patients. An ongoing debate persists regarding the efficacy of STN-DBS in ameliorating axial symptoms in PD, such as gait, swallowing, speech, and balance issues (Collomb-Clerc and Welter, 2015 ; Guimarães and Cury, 2022 ). A recent meta-analysis (Schlenstedt et al, 2017 ) revealed that STN-DBS indeed improved gait characteristics (such as stride length and speed) and alleviated the freezing of gait in patients within 48 months after electrode implantation during medication-off states.…”