Category: Surgical Therapy: Parkinson's Disease
Objective: This study was designed to compare the effects of bilateral omnidirectional and unisegmental directional deep brain stimulation in the subthalamic nucleus (STN-DBS) on axial symptoms in Parkinson’s disease (PD) patients.
Background: In PD, gait disturbances and freezing of gait represent therapeutically demanding symptoms impacting quality of life. The effects of conventional, omnidirectional STN-DBS on gait are limited. To date it is unclear, whether unisegmental DBS might be a beneficial stimulation mode to improve gait and balance.
Method: The primary outcomes of this prospective, randomised, double-blind, short-term, clinical trial were stimulation induced changes of freezing of gait (FOG-Score [1]) and spatio-temporal gait parameters recorded by the GAITRite® system. Secondary outcome was the 7-item Berg Balance scale [2]. PD patients were tested on two consecutive days in five conditions in pseudo-randomised order (stimulation: OFF, omnidirectional and anterior, postero-lateral, postero-medial segment) in the medication off-state. During unisegmental stimulation, amplitude was reduced by about 30% compared to omnidirectional stimulation (omnidirectional right STN: 2.5 ± 0.5 mA, left STN: 2.5 ± 0.9 mA). For each patient, single segments were compared and classified from best to worst for every score separately. Results are presented as mean ± standard deviation.
Results: Preliminary results of 9 patients (age 63.2 ± 4.3 years; 8 males; 14.9 ± 8.4 months postoperatively) revealed numerical, but non-significant improvements of spatio-temporal gait parameters and balance under best-segment and omnidirectional STN-DBS regime compared to DBS-OFF state, e.g. fast speed velocity: OFF: 1.44 ± 0.35 m/s; unidirectional: 1.60 ± 0.35 m/s, p = 0.35; omnidirectional: 1.61 ± 0.28 m/s, p = 0.29. The best-segment and omnidirectional STN-DBS reduced freezing of gait significantly (OFF: 18.0 ± 11.9 points; unidirectional: 7.3 ± 3.0 points, p = 0.02; omnidirectional: 7.4 ± 3.0 points, p = 0.02). The worst-segment stimulation displayed similar outcomes to the DBS-OFF state.
Conclusion: These first results suggest that unisegmental directional STN-DBS at best direction with reduced stimulation amplitude leads to comparable improvements of freezing of gait equivalent to omnidirectional stimulation.
References: [1] Ziegler, K., Schroeteler, F., Ceballos-Baumann, A. O. and Fietzek, U. M. (2010) ‘A New Rating Instrument to Assess Festination and Freezing Gait in Parkinsonian Patients’, Movement Disorders, 25(8), pp. 1012-1018. doi: 10.1002/mds.22993. [2] Chou, C. Y., Chien, C. W., Hsueh, I. P., Sheu, C. F., Wang, C. H. and Hsieh, C. L. (2006) ‘Developing a short form of the Berg Balance Scale for people with stroke’, Physical Therapy, 86(2), pp. 195-204. doi: 10.1093/ptj/86.2.195.
To cite this abstract in AMA style:
M. Kirsten, A. Gulberti, E. Gülke, C. Buhmann, W. Hamel, C. Moll, C. Gerloff, M. Pötter-Nerger. Comparison of omnidirectional versus unidirectional STN-DBS – Impact on gait and balance in Parkinson’s disease [abstract]. Mov Disord. 2020; 35 (suppl 1). https://www.mdsabstracts.org/abstract/comparison-of-omnidirectional-versus-unidirectional-stn-dbs-impact-on-gait-and-balance-in-parkinsons-disease/. Accessed June 15, 2025.« Back to MDS Virtual Congress 2020
MDS Abstracts - https://www.mdsabstracts.org/abstract/comparison-of-omnidirectional-versus-unidirectional-stn-dbs-impact-on-gait-and-balance-in-parkinsons-disease/