Objective: In this work, we aimed to characterize the differential effect of subthalamic nucleus (STN) or substantia nigra pars reticulata (SNr) stimulation on kinematic gait measures in Parkinson’s disease (PD) as primary interest.

Background: Neurostimulation of the STN for PD was described to presumably modulate spatial gait measures. However, temporal dysregulation of Parkinsonian gait is critical as it associates tightly with freezing of gait (FOG). Such temporal locomotor integration may be modulated differentially on distinct levels of the basal ganglia. Owing to its descending brainstem projections, stimulation of the SNr area might modulate locomotor integration differentially from STN stimulation.

Methods: Biomechanical parameters were analyzed during unconstrained over ground walking in thirteen PD patients with neurostimulation and FOG. Both tests were performed in three conditions: i) Off stimulation, ii) STN stimulation (alone), iii) SNr stimulation (alone). SNr stimulation was achieved by stimulating the most caudal contact of a subthalamic lead. Gait was recorded by three sensors attached on both left and right ankle and lumbar, containing a tri-axial accelerometer, gyroscope, and magnetometer.

Results: STN stimulation improved both spatial features (stride length, stride length variability), as well as temporal parameters in terms of swing time asymmetry. SNr stimulation improved the temporal features of gait in terms of swing time asymmetry. Correlation analysis suggested that more medial coordinates of the SNr contact associated with a stronger regularization effect on bilateral limb coordination.

Conclusions: Our findings suggest that SNr stimulation might complement the effect of standard subthalamic stimulation on temporal gait integration.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/effects-of-subthalamic-and-nigral-stimulation-on-gait-kinematics-in-parkinsons-disease/