Objective: To investigate the association of presynaptic dopaminergic denervation with the therapeutic effect of globus pallidus (GPi) DBS in advanced PD patients with FOG.

Background: Deep brain stimulation (DBS) has showed variable therapeutic effect on freezing of gait (FOG) in Parkinson’s disease (PD). It is unclear whether the effect of DBS on FOG is associated with the degree of dopaminergic denervation in patients with advanced PD.

Method: We retrospectively reviewed PD patients with FOG (N = 20) who underwent GPi DBS surgery. [¹⁸F] FP-CIT PET that was performed before DBS was analyzed. Postoperatively, video-based analysis for FOG severity was performed at the first DBS programming and patients were categorized into two groups according to DBS effect on FOG (11 FOG responder and 9 FOG non-responder) at medication-off state. DAT availability represented in the specific binding ratio (SBR) was calculated using region of interest (ROI) analysis for the bilateral putamen, caudate, pallidum and thalamus.

Results: FOG responders showed more male (72% vs 11%, p = 0.006) and shorter disease duration before DBS surgery (11.36 ± 2.46 years vs 15.88 ± 4.96 years, p = 0.016) compared to FOG non-responders. Mean of SBR values of [¹⁸F] FP-CIT PET in more affected putamen, and bilateral thalamus of FOG responders were significantly higher than FOG non-responders. Analysis of covariance (ANCOVA) revealed that disease duration was a major confounder of the relationship between DAT availability and the effect of GPi DBS on FOG.

Conclusion: Our study results suggest that the effect of GPi DBS on FOG is associated with disease duration before DBS surgery, which is closely related to reduction of DAT availability in PD. These results may provide useful insight for the selection of candidate for DBS surgery and prediction of therapeutic effects of GPi DBS in advanced PD patients with FOG

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MDS Abstracts - https://www.mdsabstracts.org/abstract/association-of-presynaptic-dopaminergic-denervation-with-therapeutic-effects-of-globus-pallidus-deep-brain-stimulation-on-freezing-of-gait-in-advanced-parkinsons-disease/