Ryul Kim1,2, Han-Joon Kim1, Chaewon Shin3, Hyeyoung Park1, Aryun Kim1, Sun Ha Paek4, Beomseok Jeon1. 1. Departments of1Neurology and. 2. 2Department of Neurology, Aerospace Medical Center, Republic of Korea Air Force, Cheongju, Chungcheongbuk-do, Korea. 3. 3Department of Neurology, Kyung Hee University Hospital, Seoul; and. 4. 4Neurosurgery, Seoul National University Hospital, College of Medicine.
Abstract
OBJECTIVE: Subthalamic nucleus deep brain stimulation (STN DBS) is effective against freezing of gait (FOG) in Parkinson's disease (PD); however, whether this effect persists over the long term is debated. The aim of the current study was to investigate the long-term effect of STN DBS on FOG in patients with PD. METHODS: Data on 52 cases in which PD patients received bilateral STN DBS were obtained from a prospective registry. The authors blindly analyzed FOG incidence and its severity from the videotapes of a 5-m walking task at the baseline and at the 1-, 2-, and 5- or 7-year follow-up visits. They also compared the axial score from the Unified Parkinson's Disease Rating Scale (UPDRS) part III, UPDRS part II (UPDRS-II) item 14, and the FOG questionnaire (FOG-Q). Postoperatively, video-based FOG analysis and the axial score were evaluated under 4 conditions (off-medication/off-stimulation, off-medication/on-stimulation, on-medication/off-stimulation, and on-medication/on-stimulation), and UPDRS-II item 14 and the FOG-Q score were evaluated under 2 conditions (off-medication/on-stimulation and on-medication/on-stimulation). RESULTS: During the off-medication state, the on-stimulation condition improved FOG outcomes, except for video-based FOG severity, up to the last follow-up compared with the baseline. Video-based FOG outcomes and the axial score during the off-medication state were improved with the on-stimulation condition up to the last follow-up compared with the off-stimulation condition. During the on-medication state, the on-stimulation condition did not improve any FOG outcome compared with the baseline; however, it improved video-based FOG outcomes up to the 2-year follow-up and the axial score up to the last follow-up compared with the off-stimulation condition. CONCLUSIONS: Our findings suggest that STN DBS has a long-term effect on FOG in the off-medication state. However, STN DBS did not show a long-term effect on FOG in the on-medication state, although it had a short-term effect until the 2-year follow-up.
OBJECTIVE: Subthalamic nucleus deep brain stimulation (STNDBS) is effective against freezing of gait (FOG) in Parkinson's disease (PD); however, whether this effect persists over the long term is debated. The aim of the current study was to investigate the long-term effect of STNDBS on FOG in patients with PD. METHODS: Data on 52 cases in which PDpatients received bilateral STNDBS were obtained from a prospective registry. The authors blindly analyzed FOG incidence and its severity from the videotapes of a 5-m walking task at the baseline and at the 1-, 2-, and 5- or 7-year follow-up visits. They also compared the axial score from the Unified Parkinson's Disease Rating Scale (UPDRS) part III, UPDRS part II (UPDRS-II) item 14, and the FOG questionnaire (FOG-Q). Postoperatively, video-based FOG analysis and the axial score were evaluated under 4 conditions (off-medication/off-stimulation, off-medication/on-stimulation, on-medication/off-stimulation, and on-medication/on-stimulation), and UPDRS-II item 14 and the FOG-Q score were evaluated under 2 conditions (off-medication/on-stimulation and on-medication/on-stimulation). RESULTS: During the off-medication state, the on-stimulation condition improved FOG outcomes, except for video-based FOG severity, up to the last follow-up compared with the baseline. Video-based FOG outcomes and the axial score during the off-medication state were improved with the on-stimulation condition up to the last follow-up compared with the off-stimulation condition. During the on-medication state, the on-stimulation condition did not improve any FOG outcome compared with the baseline; however, it improved video-based FOG outcomes up to the 2-year follow-up and the axial score up to the last follow-up compared with the off-stimulation condition. CONCLUSIONS: Our findings suggest that STNDBS has a long-term effect on FOG in the off-medication state. However, STNDBS did not show a long-term effect on FOG in the on-medication state, although it had a short-term effect until the 2-year follow-up.
Entities:
Keywords:
DBS = deep brain stimulation; FOG = freezing of gait; FOG-Q = FOG questionnaire; GEE = generalized estimating equation; ICC = intraclass correlation coefficient; PD = Parkinson’s disease; Parkinson’s disease; SNUH = Seoul National University Hospital; STN = subthalamic nucleus; UPDRS = Unified Parkinson’s Disease Rating Scale; UPDRS-II = UPDRS part II; UPDRS-III = UPDRS part III; deep brain stimulation; freezing of gait; functional neurosurgery; subthalamic
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