Michael T Barbe1, Lisa Tonder2, Paul Krack3, Bettina Debû4, Michael Schüpbach3,5,6, Steffen Paschen7, Till A Dembek1, Andrea A Kühn8, Valerie Fraix4,9, Christine Brefel-Courbon10, Lars Wojtecki11, David Maltête12, Phillippe Damier13, Friederike Sixel-Döring14, Daniel Weiss15, Marcus Pinsker16, Tatiana Witjas17, Stephane Thobois18, Carmen Schade-Brittinger19, Jörn Rau19, Jean-Luc Houeto20, Andreas Hartmann5, Lars Timmermann1,21, Alfons Schnitzler11, Valerie Stoker2, Marie Vidailhet22, Günther Deuschl7. 1. Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany. 2. Medtronic, Minneapolis, Minnesota, USA. 3. Department of Neurology, University Hospital Bern and University of Bern, Bern, Switzerland. 4. Université Grenoble Alpes, INSERM 1216, Grenoble Institut Neurosciences, Grenoble, France; Neurology Department, Grenoble University Hospital, Grenoble, France. 5. Assistance-Publique Hôpitaux de Paris; Centre d'Investigation Clinique 9503, Institut du Cerveau et de la Moelle épinière; Département de Neurologie, Université Pierre et Marie Curie-Paris 6 et INSERM, CHU Pitié-Salpêtrière, Paris, France. 6. Institute of Neurology, Konolfingen, Switzerland. 7. Department of Neurology, UKSH, Kiel Campus Christian-Albrechts-University, Kiel, Germany. 8. Department of Neurology, Charité-Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany. 9. Neurology Department, Grenoble University Hospital, Grenoble, France. 10. Department of Neurology, INSERM Unite 1214, University Hospital Toulouse, France. 11. Institute of Clinical Neuroscience and Medical Psychology, and Department of Neurology, Heinrich-Heine University Duesseldorf, Duesseldorf, Germany. 12. Department of Neurology, Rouen University Hospital and University of Rouen, Rouen, France; INSERM U1239, Laboratory of Neuronal and Neuroendocrine Differentiation and Communication, Mont-Saint-Aignan, France. 13. CHU Nantes, INSERM, CIC1413, Hôpital Laënnec, Nantes, France. 14. Paracelsus-Elena-Klinik Kassel, Kassel, Germany. 15. Centre of Neurology, Department for Neurodegenerative Diseases, and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany. 16. Division of Stereotactic and Functional Neurosurgery, University Medical Center, Freiburg, Freiburg, Germany. 17. Department of Neurology, Timone University Hospital, UMR 7289, CNRS Marseille, Marseille, France. 18. Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Centre Expert Parkinson, Bron, France; Université Lyon, Université Claude Bernard Lyon 1, Faculté de Médecine Lyon Sud Charles Mérieux, Oullins, France. 19. The Coordinating Center for Clinical Trials, Philipps University, Marburg, Germany. 20. Department of Neurology, CIC-INSERM 1402, CHU of Poitiers, University of Poitiers, Poitiers, France. 21. Universitätsklinikum Giessen und Marburg, Marburg Campus, Marburg, Germany. 22. Sorbonne Université, ICM UMR1127, INSERM &1127, CNRS 7225, Department of Neurology, Salpêtriere University Hospital, AP-HP, Paris, France.
Abstract
BACKGROUND: Effects of DBS on freezing of gait and other axial signs in PD patients are unclear. OBJECTIVE: Secondary analysis to assess whether DBS affects these symptoms within a large randomized controlled trial comparing DBS of the STN combined with best medical treatment and best medical treatment alone in patients with early motor complications (EARLYSTIM-trial). METHODS:One hundred twenty-four patients were randomized in the stimulation group and 127 patients in the best medical treatment group. Presence of freezing of gait was assessed in the worst condition based on item-14 of the UPDRS-II at baseline and follow-up. The posture, instability, and gait-difficulty subscore of the UPDRS-III, and a gait test including quantification of freezing of gait and number of steps, were performed in both medication-off and medication-on conditions. RESULTS: Fifty-two percent in both groups had freezing of gait at baseline based on UPDRS-II. This proportion decreased in the stimulation group to 34%, but did not change in the best medical treatment group at 24 months (P = 0.018). The steps needed to complete the gait test decreased in the stimulation group and was superior to the best medical treatment group (P = 0.016). The axial signs improved in the stimulation group compared to the best medical treatment group (P < 0.01) in both medication-off and medication-on conditions. CONCLUSIONS: Within the first 2 years of DBS, freezing of gait and other axial signs improved in the medication-off condition compared to best medical treatment in these patients.
RCT Entities:
BACKGROUND: Effects of DBS on freezing of gait and other axial signs in PDpatients are unclear. OBJECTIVE: Secondary analysis to assess whether DBS affects these symptoms within a large randomized controlled trial comparing DBS of the STN combined with best medical treatment and best medical treatment alone in patients with early motor complications (EARLYSTIM-trial). METHODS: One hundred twenty-four patients were randomized in the stimulation group and 127 patients in the best medical treatment group. Presence of freezing of gait was assessed in the worst condition based on item-14 of the UPDRS-II at baseline and follow-up. The posture, instability, and gait-difficulty subscore of the UPDRS-III, and a gait test including quantification of freezing of gait and number of steps, were performed in both medication-off and medication-on conditions. RESULTS: Fifty-two percent in both groups had freezing of gait at baseline based on UPDRS-II. This proportion decreased in the stimulation group to 34%, but did not change in the best medical treatment group at 24 months (P = 0.018). The steps needed to complete the gait test decreased in the stimulation group and was superior to the best medical treatment group (P = 0.016). The axial signs improved in the stimulation group compared to the best medical treatment group (P < 0.01) in both medication-off and medication-on conditions. CONCLUSIONS: Within the first 2 years of DBS, freezing of gait and other axial signs improved in the medication-off condition compared to best medical treatment in these patients.
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