Objective: To demonstrate the combined effect of low frequency subthalamic nucleus-deep brain stimulation (STN-DBS) and spinal cord stimulation (SCS) on gait in Parkinson’s disease.

Background: Axial symptoms of Parkinson’s disease (PD) such as postural instability and freezing of gait have unpredictable responses to levodopa and deep brain stimulation. Low frequency STN-DBS has shown promising results in improving gait and recent reports also highlight the possible gait benefits of spinal cord stimulation.  We describe a patient with advanced PD whose gait responded to both low frequency STN-DBS and SCS.

Method: Clinical Case.

Results: A 72-year-old patient with advanced PD was implanted with bilateral STN-DBS at age 67 to address motor fluctuations. One year later his shuffling gait increased and he developed freezing episodes that were unresponsive to higher levodopa doses, but improved with low frequency stimulation (70Hz).  The patient was stable for the next year during which time he was implanted with a spinal cord stimulator for chronic lower back pain. Six months afterwards, his gait freezing returned and worsened when his DBS was turned off. While maintaining his low frequency STN-DBS, his SCS frequency was lowered from 1000Hz to 60Hz with an immediate reduction in his freezing episodes. These benefits were maintained over the subsequent months with an increase in SCS frequency to 130Hz and a pulse width of 400ms. His levodopa equivalent daily dose was reduced from 1300 to 1225 mg during the same period.

Conclusion: SCS combined with DBS shows promise in the treatment of axial symptoms in advanced PD. Further research is needed in a larger cohort of patients to standardize stimulation parameters, determine ideal candidates, and study the mechanism of this therapeutic effect.

« Back to MDS Virtual Congress 2020

MDS Abstracts - https://www.mdsabstracts.org/abstract/freezing-of-gait-responsive-to-low-frequency-stn-dbs-and-spinal-cord-stimulation/