Category: Surgical Therapy: Parkinson's Disease
Objective: To assess the effects of directional STN-DBS on gait and balance in PD patients
Background: STN-DBS is efficient to treat motor signs in PD patients. Its effects on freezing of gait (FOG) are variable across patients, depending partly from the stimulating contact location.
Method: In this pilot study, we assessed the effects of directional STN-DBS on gait and balance in 10 PD patients with FOG, using gait recordings and validated clinical scales (gait and balance scale-GABS, freezing-of-gait questionnaire-FOGQ). Patients were assessed before surgery (Off/On-dopa), and 6 months after with: 1) single-ring, 2) directional STN-DBS with current shaping including the STN central part (gait ‘hot-spot’), 3) STN dorsolateral part (sensorimotor area), 4) STN ventral part, or 5) outside of the STN and 5) Off STN-DBS, with a randomized cross-over double-blind design (Off-dopa). Patients were also reassessed one month later with chronic gait ‘hot-spot’ DBS (Off/On-dopa). We compared the effects of each STN-DBS conditions using a linear mixed model.
Results: Up to now, 8 patients were assessed 6 months after surgery. In these patients, all active STN-DBS conditions improved motor disability, axial and GABS scores relative to Off STN-DBS condition (mean improvement of 70%, 54%, 65%, respectively). The effects of single-ring, ‘gait hotspot’ and sensorimotor STN-DBS conditions on motor disability were not different. The axial and GABS scores were significantly lower with the gait ‘hot-spot’ STN-DBS relative to the sensorimotor, ventral and outside conditions, with no significant difference with the single-ring condition. All STN-DBS conditions improved stride length and velocity relative to Off STN-DBS, with better gait parameters with single-ring and gait ‘hot-spot’ STN-DBS relative to sensorimotor STN-DBS, with lower gait phases durations, number of FOG episodes and gait asymmetry, and higher step length and turn amplitude. With chronic gait ‘hot-spot’ STN-DBS, FOGQ score was lower relative to chronic single-ring STN-DBS. No major side-effects of STN-DBS occurred.
Conclusion: These preliminary result suggest that directional central-gait ‘hot-spot’ STN-DBS is more efficient than dorsolateral-sensorimotor STN-DBS to improve gait and balance disorders in PD patients, with also a dramatic improvement in other parkinsonian symptoms.
To cite this abstract in AMA style:
S. Cherif, C. Olivier, J. Bourilhon, D. Bannier, D. Maltête, B. Lau, S. Derrey, E. Bardinet, C. Karachi, M. Welter. Effects of directional subthalamic deep brain stimulation on gait and balance in Parkinson Disease patients. [abstract]. Mov Disord. 2022; 37 (suppl 2). https://www.mdsabstracts.org/abstract/effects-of-directional-subthalamic-deep-brain-stimulation-on-gait-and-balance-in-parkinson-disease-patients/. Accessed May 13, 2025.« Back to 2022 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/effects-of-directional-subthalamic-deep-brain-stimulation-on-gait-and-balance-in-parkinson-disease-patients/