INTRODUCTION: Experimental studies suggest that low-frequency (LF) (63 Hz) deep brain stimulation (DBS) of the substantia nigra pars reticulata (SNr) could be useful to regulate gait disorders refractory to medical treatment in Parkinson's disease (PD). The SNr neurons could act as high-frequency (HF) pacemakers within locomotor control systems. Currently, no specific therapies can treat gait disorders in PD with insufficient response to dopaminergic treatment. OBJECTIVE: To investigate whether LF-SNr-DBS combined with standard HF stimulation of the subthalamic nucleus (STN) is clinically relevant in improving gait disorders that no longer respond to levodopa in PD patients, compared with HF-STN or LF-SNr stimulation alone. METHODS: Patients received LF-SNr or HF-STN stimulation alone or combined (COMB) stimulation of both nuclei (crossover design). The nucleus to be stimulated was randomly assigned and clinical evaluations performed by a blinded examiner after three months follow-up for each. Clinical assessment included the Freezing of Gait questionnaire, Tinetti Balance and Walking Assessing tool, and Unified Parkinson's Disease Rating. RESULTS: We included six patients (mean age 59.1 years, disease duration 16.1 years). All patients suffered motor fluctuations and dyskinesias. The best results were obtained with COMB in four patients (who preferred and remained with COMB over 3 years of follow-up) and with HF-STN in two patients. SNr stimulation alone did not produce better results than COMB or STN in any patient. CONCLUSION:COMB and HF-STN stimulation improved PD-associated gait disorders in this preliminary case series, sustained over time. Further multicenter investigations are required to better explore this therapeutic option.
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INTRODUCTION: Experimental studies suggest that low-frequency (LF) (63 Hz) deep brain stimulation (DBS) of the substantia nigra pars reticulata (SNr) could be useful to regulate gait disorders refractory to medical treatment in Parkinson's disease (PD). The SNr neurons could act as high-frequency (HF) pacemakers within locomotor control systems. Currently, no specific therapies can treat gait disorders in PD with insufficient response to dopaminergic treatment. OBJECTIVE: To investigate whether LF-SNr-DBS combined with standard HF stimulation of the subthalamic nucleus (STN) is clinically relevant in improving gait disorders that no longer respond to levodopa in PDpatients, compared with HF-STN or LF-SNr stimulation alone. METHODS:Patients received LF-SNr or HF-STN stimulation alone or combined (COMB) stimulation of both nuclei (crossover design). The nucleus to be stimulated was randomly assigned and clinical evaluations performed by a blinded examiner after three months follow-up for each. Clinical assessment included the Freezing of Gait questionnaire, Tinetti Balance and Walking Assessing tool, and Unified Parkinson's Disease Rating. RESULTS: We included six patients (mean age 59.1 years, disease duration 16.1 years). All patients suffered motor fluctuations and dyskinesias. The best results were obtained with COMB in four patients (who preferred and remained with COMB over 3 years of follow-up) and with HF-STN in two patients. SNr stimulation alone did not produce better results than COMB or STN in any patient. CONCLUSION: COMB and HF-STN stimulation improved PD-associated gait disorders in this preliminary case series, sustained over time. Further multicenter investigations are required to better explore this therapeutic option.
Authors: Daniel Weiss; Anna Schoellmann; Michael D Fox; Nicolaas I Bohnen; Stewart A Factor; Alice Nieuwboer; Mark Hallett; Simon J G Lewis Journal: Brain Date: 2020-01-01 Impact factor: 13.501
Authors: Sina R Potel; Sara Marceglia; Sara Meoni; Suneil K Kalia; Rubens G Cury; Elena Moro Journal: Curr Neurol Neurosci Rep Date: 2022-07-15 Impact factor: 6.030
Authors: Shervin Rahimpour; Wendy Gaztanaga; Amol P Yadav; Stephano J Chang; Max O Krucoff; Iahn Cajigas; Dennis A Turner; Doris D Wang Journal: Neuromodulation Date: 2020-12-26
Authors: Adolfo Ramirez-Zamora; James Giordano; Aysegul Gunduz; Jose Alcantara; Jackson N Cagle; Stephanie Cernera; Parker Difuntorum; Robert S Eisinger; Julieth Gomez; Sarah Long; Brandon Parks; Joshua K Wong; Shannon Chiu; Bhavana Patel; Warren M Grill; Harrison C Walker; Simon J Little; Ro'ee Gilron; Gerd Tinkhauser; Wesley Thevathasan; Nicholas C Sinclair; Andres M Lozano; Thomas Foltynie; Alfonso Fasano; Sameer A Sheth; Katherine Scangos; Terence D Sanger; Jonathan Miller; Audrey C Brumback; Priya Rajasethupathy; Cameron McIntyre; Leslie Schlachter; Nanthia Suthana; Cynthia Kubu; Lauren R Sankary; Karen Herrera-Ferrá; Steven Goetz; Binith Cheeran; G Karl Steinke; Christopher Hess; Leonardo Almeida; Wissam Deeb; Kelly D Foote; Michael S Okun Journal: Front Hum Neurosci Date: 2020-03-27 Impact factor: 3.169