Objective: To report the effects of continuous and intermittent spinal cord stimulation (SCS) on gait in two patients with Parkinson’s disease (PD) with refractory gait impairment. To report the effects of continuous and intermittent spinal cord stimulation (SCS) on gait in two patients with Parkinson’s disease (PD) with refractory gait impairment.

Background: Treatment of gait disorders in PD remains challenging. A positive effect of epidural spinal cord stimulation (SCS) on locomotive activity has been reported in small cohorts of PD patients [1]. However, our experience showed that some patients lose benefit over time, suggesting a possible kind of tolerance, as perceived in patients with Essential tremor, that could account for part of this issue. Here, we report two cases where cycling stimulation was tried in order to explore this question.

Method: Two patients with PD and subthalamic DBS refractory gait symptoms and frequent freezing of gait (FoG) underwent dorsal SCS. Settings were adjusted over a semester to the best therapeutic effect. We evaluated gait on best continuous stimulation, off stimulation and cycling stimulation on three visits via clinical tests including 10 meter walk (10m) and new freezing of gait questionnaire (NFOG). All patients signed informed consent.

Results: Patient one is a 72 year old male, with 29 years of idiopathic PD, with STN DBS for 9 years. Patient two is a 55 year old male, with 10 years of idiopathic PD and STN DBS for 4 years. Both patients underwent successful implantation.
Patient one improved from 39s off stim to 10s on stim on 10m, and from 27 to 26 on NFOG. Cycling stimulation yielded similar scores, 11s and 25 respectively.  Patient two improved from 17s off stim to 15s on stim on 10m, while scoring 12 on NFOG on both situations. Cycling stimulation, however, improved the scores to 10s and 9 respectively.

Conclusion: While the initial usual stimulation settings with continuous stimulation showed minor improvement for both patients, the effect was not robust to significantly alter patient’s perception of freezing of gait via NFOG. Switching to cycling stimulation improved gait and FOG perception in a more significant manner only on patient two. Intermittent stimulation could be useful as a secondary tool to improve the effectiveness of SCS on non responders.

References: 1. Pinto de Souza, C., Hamanni, C., Oliveira Souza, C., Lopez Contreras, W.O., Dos Santos Ghilardi, M.G., Cury, R.G., Reis Barbosa, E., Jacobsen Teixeira, M., and Talamoni Fonoff, E. (2017). Spinal cord stimulation improves gait in patients with Parkinson’s disease previously treated with deep brain stimulation. Mov. Disord. Off. J. Mov. Disord. Soc. 2. Fasano, A. Helmich, RC. Tremor habituation to deep brain stimulation: Underlying mechanisms and solutions. Mov Disord. 2019 Dec;

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MDS Abstracts - https://www.mdsabstracts.org/abstract/spinal-cord-stimulation-on-parkinsons-disease-continuous-or-intermittent-stimulation/