Christopher P Hurt1,2, Daniel J Kuhman1, Barton L Guthrie3, Carla R Lima1, Melissa Wade4, Harrison C Walker4,5. 1. Rehabilitation Sciences, University of Alabama at Birmingham, Birmingham, AL, United States. 2. Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, United States. 3. Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, United States. 4. Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, United States. 5. Department of Biomedical Engineering, University of Alabama at Birmingham, Birmingham, AL, United States.
Abstract
Introduction: Although deep brain stimulation (DBS) often improves levodopa-responsive gait symptoms, robust therapies for gait dysfunction from Parkinson's disease (PD) remain a major unmet need. Walking speed could represent a simple, integrated tool to assess DBS efficacy but is often not examined systematically or quantitatively during DBS programming. Here we investigate the reliability and functional significance of changes in gait by directional DBS in the subthalamic nucleus. Methods: Nineteen patients underwent unilateral subthalamic nucleus DBS surgery with an eight-contact directional lead (1-3-3-1 configuration) in the most severely affected hemisphere. They arrived off dopaminergic medications >12 h preoperatively and for device activation 1 month after surgery. We measured a comfortable walking speed using an instrumented walkway with DBS off and at each of 10 stimulation configurations (six directional contacts, two virtual rings, and two circular rings) at the midpoint of the therapeutic window. Repeated measures of ANOVA contrasted preoperative vs. maximum and minimum walking speeds across DBS configurations during device activation. Intraclass correlation coefficients examined walking speed reliability across the four trials within each DBS configuration. We also investigated whether changes in walking speed related to modification of step length vs. cadence with a one-sample t-test. Results: Mean comfortable walking speed improved significantly with DBS on vs. both DBS off and minimum speeds with DBS on (p < 0.001, respectively). Pairwise comparisons showed no significant difference between DBS off and minimum comfortable walking speed with DBS on (p = 1.000). Intraclass correlations were ≥0.949 within each condition. Changes in comfortable walk speed were conferred primarily by changes in step length (p < 0.004). Conclusion: Acute assessment of walking speed is a reliable, clinically meaningful measure of gait function during DBS activation. Directional and circular unilateral subthalamic DBS in appropriate configurations elicit acute and clinically significant improvements in gait dysfunction related to PD. Next-generation directional DBS technologies have significant potential to enhance gait by individually tailoring stimulation parameters to optimize efficacy.
Introduction: Although deep brain stimulation (DBS) often improves levodopa-responsive gait symptoms, robust therapies for gait dysfunction from Parkinson's disease (PD) remain a major unmet need. Walking speed could represent a simple, integrated tool to assess DBS efficacy but is often not examined systematically or quantitatively during DBS programming. Here we investigate the reliability and functional significance of changes in gait by directional DBS in the subthalamic nucleus. Methods: Nineteen patients underwent unilateral subthalamic nucleus DBS surgery with an eight-contact directional lead (1-3-3-1 configuration) in the most severely affected hemisphere. They arrived off dopaminergic medications >12 h preoperatively and for device activation 1 month after surgery. We measured a comfortable walking speed using an instrumented walkway with DBS off and at each of 10 stimulation configurations (six directional contacts, two virtual rings, and two circular rings) at the midpoint of the therapeutic window. Repeated measures of ANOVA contrasted preoperative vs. maximum and minimum walking speeds across DBS configurations during device activation. Intraclass correlation coefficients examined walking speed reliability across the four trials within each DBS configuration. We also investigated whether changes in walking speed related to modification of step length vs. cadence with a one-sample t-test. Results: Mean comfortable walking speed improved significantly with DBS on vs. both DBS off and minimum speeds with DBS on (p < 0.001, respectively). Pairwise comparisons showed no significant difference between DBS off and minimum comfortable walking speed with DBS on (p = 1.000). Intraclass correlations were ≥0.949 within each condition. Changes in comfortable walk speed were conferred primarily by changes in step length (p < 0.004). Conclusion: Acute assessment of walking speed is a reliable, clinically meaningful measure of gait function during DBS activation. Directional and circular unilateral subthalamic DBS in appropriate configurations elicit acute and clinically significant improvements in gait dysfunction related to PD. Next-generation directional DBS technologies have significant potential to enhance gait by individually tailoring stimulation parameters to optimize efficacy.
Authors: Daniela Navratilova; Alois Krobot; Pavel Otruba; Martin Nevrly; David Krahulik; Petr Kolar; Barbora Kolarova; Michaela Kaiserova; Katerina Mensikova; Miroslav Vastik; Sandra Kurcova; Petr Kanovsky Journal: Front Neurosci Date: 2020-08-14 Impact factor: 4.677
Authors: Jaimie A Roper; Nyeonju Kang; Juliana Ben; James H Cauraugh; Michael S Okun; Chris J Hass Journal: J Neurol Date: 2016-04-28 Impact factor: 4.849
Authors: Chris J Hass; Mark Bishop; Mariana Moscovich; Elizabeth L Stegemöller; Jared Skinner; Irene A Malaty; Aparna Wagle Shukla; Nikolaus McFarland; Michael S Okun Journal: J Neurol Phys Ther Date: 2014-10 Impact factor: 3.649
Authors: Nicolas Bayle; Amar S Patel; Diana Crisan; Lanjun J Guo; Emilie Hutin; Donald J Weisz; Steven T Moore; Jean-Michel Gracies Journal: PLoS One Date: 2016-04-25 Impact factor: 3.240
Authors: Deepak K Ravi; Christian R Baumann; Elena Bernasconi; Michelle Gwerder; Niklas K Ignasiak; Mechtild Uhl; Lennart Stieglitz; William R Taylor; Navrag B Singh Journal: Neurorehabil Neural Repair Date: 2021-09-22 Impact factor: 3.919