Objective: The primary objective was to investigate the therapeutic effect of spinal cord stimulation (SCS) on gait dysfunction including freezing of gait (FOG) in advanced Parkinson’s disease (PD) patients. The secondary objectives were to determine the effects of pulse width and frequency SCS parameters on FOG and spatiotemporal gait parameters.

Background: Dopaminergic therapy and deep brain stimulation (DBS) alleviate motor features in PD however their effects on axial features such as gait dysfunction reduces with disease progression. Epidural SCS may be a new therapeutic approach for levodopa-resistant motor symptoms in PD. 

Methods: A total of five advanced PD male patients (mean age of 71±10 years with 14±4 years with PD) not eligible for DBS, with significant gait disturbances, FOG and postural instability underwent mid-thoracic SCS. A range of SCS settings at 200-500 microseconds and 30-130 Hz at suprathreshold intensity were tested in eight study visits over a six-months period. A 20-foot Protokinetics Zeno Walkway measured dynamic gait characteristics, such as step length, stride width, stride velocity, step, stance and swing times. Timed sit-to-stand and automated FOG detection using foot pressures were also analyzed. FOG questionnaire, Unified Parkinson’s Disease Rating Scale (UPDRS) motor items, Activities-specific balance confidence scale (ABC), and Parkinson’s disease questionnaire (PDQ-8) were completed at each study visit. 

Results: Three patients found SCS setting combination of 300 microseconds and 60 Hz provided the best improvement in timed sit-to-stand, stride velocity and step length with a mean improvement of 63.8%, 76.2% and 91.1%, respectively. Two patients found a combination of 130 Hz with 200 or 300 microseconds more beneficial with a mean improvement by 58.4% for timed sit-to-stand, 36.6% for stride velocity and 56.7% for step length. Six-months post-implantation, there was a mean improvement by 39.4% in the UPDRS motor score, by 26.8% in the FOG questionnaire, and by 116.9% in the ABC score. The mean number of FOG episodes reduced significantly from 16 pre-surgery to 0 at six-month period while patients were “ON” levodopa and OFF stimulation.

Conclusions: This pilot study demonstrated the safety and therapeutic efficacy of SCS in advanced PD. A larger clinical study will be utilized to investigate the neurophysiological changes occurring at different SCS parameters. 

References: 1.        de Andrade EM, Ghilardi MG, Cury RG, et al. Spinal cord stimulation for Parkinson’s disease: a systematic review. Neurosurg Rev. 2016;39:27-35. 

2.        Souza CP de, Hamani C, Souza CO, et al. Spinal cord stimulation improves gait in Parkinson’s disease patients previously treated with DBS. Mov Disord. 2016;Nov 10:1-5. 

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MDS Abstracts - https://www.mdsabstracts.org/abstract/spinal-cord-stimulation-reduces-freezing-of-gait-and-improves-gait-in-advanced-parkinsons-disease/