Spinal cord stimulation improves gait in patients with Parkinson's disease previously treated with deep brain stimulation

• Published in: Movement disorders Vol. 32; no. 2; pp. 278 - 282
• Main Authors: Pinto de Souza, Carolina, Hamani, Clement, Oliveira Souza, Carolina, Lopez Contreras, William Omar, dos Santos Ghilardi, Maria Gabriela, Cury, Rubens Gisbert, Reis Barbosa, Egberto, Jacobsen Teixeira, Manoel, Talamoni Fonoff, Erich
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01-02-2017
• Subjects: Aged; Deep Brain Stimulation; Female; freezing of gait; Gait Disorders, Neurologic - etiology; Gait Disorders, Neurologic - therapy; Humans; locomotion; Male; Middle Aged; Movement disorders; Outcome Assessment (Health Care); parkinson; Parkinson Disease - complications; Parkinson Disease - therapy; postural instability and gait disturbances; Single-Blind Method; spinal cord; Spinal Cord Stimulation - methods; postural instability and gait disturbances; parkinson; spinal cord; freezing of gait; locomotion
• ISSN: 0885-3185; 1531-8257
• DOI: 10.1002/mds.26850

ABSTRACT
Background
Deep brain stimulation and levodopatherapy ameliorate motor manifestations in Parkinson's disease, but their effects on axial signs are not sustained in the long term.
Objectives
The objective of this study was to investigate the safety and efficacy of spinal cord stimulation on gait disturbance in advanced Parkinson's disease.
Methods
A total of 4 Parkinson's disease patients who experienced significant postural instability and gait disturbance years after chronic subthalamic stimulation were treated with spinal cord stimulation at 300 Hz. Timed‐Up‐GO and 20‐meter‐walk tests, UPDRS III, freezing of gait questionnaire, and quality‐of‐life scores were measured at 6 months and compared to baseline values. Blinded assessments to measure performance in the Timed‐Up‐GO and 20‐meter‐walk tests were carried out during sham stimulation at 300 Hz and 60 Hz.
Results
Patients treated with spinal cord stimulation had approximately 50% to 65% improvement in gait measurements and 35% to 45% in UPDRS III and quality‐of‐life scores. During blinded evaluations, significant improvements in the Timed‐Up‐GO and 20‐meter‐walk tests were only recorded at 300 Hz.
Conclusion
Spinal cord stimulation at 300 Hz was well tolerated and led to a significant improvement in gait. © 2016 International Parkinson and Movement Disorder Society.