Objective: To determine variables that predict outcome of gait kinematics with chronic deep brain stimulation (DBS) of the subthalamic nucleus (STN) or globus pallidus internus (GPi) in patients with Parkinson’s disease (PD)

Background: The effects of DBS on gait are variable. Few studies prospectively followed patients with gait kinematics. We hypothesize that STN or GPi DBS exert acute and chronic effects on gait, and that pre-DBS clinical variables or acute effects of DBS on gait could predict chronic gait outcomes

Method: Gait kinematics were collected on PD patients with STN or GPi DBS using a pressure sensitive walkway (Protokinetics Zeno). Patients were followed prospectively, and data were collected off meds at baseline before initial DBS activation (n=104), acutely after activation (n=101), chronically at 1 month (n=75) and 12 months (n=82). The main outcome was gait velocity. Mixed-effects linear model was used to evaluate gait velocity over time and the effects of covariates including age, disease duration, MOCA, and levodopa equivalent daily dose (LEDD). To evaluate the predictors of velocity change at 12-months, we analyzed its linear relationship to acute and 1-month velocity changes, and to pre-DBS clinical scores including MDS-UPDRS-III and axial sub-score

Results: DBS improves gait velocity acutely (p < 0.0001), and the effects are maintained after 12 months (p < 0.0001). Covariates including age, disease duration, LEDD, and MOCA, did not significantly change the effect of DBS on velocity. Chronic 12-month velocity changes were strongly related to acute (Adj. R² = 0.58, p< 0.0001) and chronic 1-month (Adj. R² = 0.71, p< 0.0001) velocity changes indicating that the direction and magnitude of velocity change acutely and at 1 month can predict velocity change at 12 months. Pre-DBS axial sub-score levodopa responsiveness correlated with velocity change at 12-months (Adj R²: 0.05, p=0.021), especially in patients with bilateral STN stimulation (Adj R²: 0.29, p=0.0008)

Conclusion: There were immediate effects of DBS on gait kinematics that were maintained chronically after 12 months. The direction and magnitude of immediate effects on gait velocity at initial programming could accurately predict velocity change at 12 months. Pre-DBS axial sub-score levodopa responsiveness could be beneficial in predicting long term DBS related gait changes

Step velocity in all DBS patients over time

Predictors of velocity change at 12 months

Pre-DBS axial sub-score and velocity change

Pre-DBS axial sub-score and velocity change

Mixed-effects model with covariates

References: NA

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MDS Abstracts - https://www.mdsabstracts.org/abstract/predicting-long-term-outcome-of-gait-kinematics-with-chronic-deep-brain-stimulation-in-patients-with-parkinsons-disease/