Objective: In this study we aimed to identify clinical and kinematic features that correlate to favorable freezing of gait (FOG) outcome from standard subthalamic neurostimulation in patients with idiopathic Parkinson’s disease (PD).

Background: FOG constitutes a major unmet therapeutic need in advanced PD. As patients show variable postoperative outcomes of FOG from standard subthalamic neurostimulation, it is warranted to establish surrogates of the therapeutic outcome.

Method: We conducted a prospective observational clinical study with a clinical and biomechanical characterization of gait function before and after surgery. Biomechanical measures of gait were assessed by three inertial measurement units attached to limbs and lumbar position including triaxial accelerometer, gyroscope and magnetometer. The clinical severity of FOG was assessed by the Freezing of Gait Assessment Course (FOG-AC). The preoperative visit included assessments in both ‘off’ and ‘on’ dopaminergic state. Patients were reassessed on the same measures six months after the implantation in their best individual treatment ‘on medication, on stimulation’.

Results: We observed a positive FOG outcome, when the ‘range of motion’ (ROM) at ankle and knee level, as well as stride length were preoperatively levodopa responsive. Also, preoperative levodopa responsiveness of FOG itself pointed to a better outcome.

Conclusion: These preliminary observations encourage us to develop a predictive model to stratify preoperative patients with FOG for subthalamic deep brain stimulation procedures. This is crucial given that FOG in many patients dominates self-perceived impairment of health-related quality of life.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/preoperative-stratification-of-gait-outcome-from-subthalamic-nucleus-stimulation/