Objective: To determine whether single dose non-invasive vagus nerve stimulation (nVNS) enhances gait performance in Parkinson’s (PD).

Background: Loss of cholinergic neurons from nucleus basalis of Meynert (nbM) may be a major contributor to the functional decline in gait and cognition in PD (1). Studies of cholinesterase inhibitors for the management of PD-associated gait disorder are underway, however, drugs are not without side-effects. We have recently shown in healthy controls that nVNS can activate cholinergic neurons in the nbM.

Method: This was a single dose double-blind, sham/placebo-controlled study of 30 patients with Parkinson’s, who were equally randomised into sham vs. active nVNS groups. Gait was measured using an instrumented walkway and sensors, with preliminary analysis focussing on step time and step length variability, as predictors of early dopa-resistant gait impairment (2). Attentional fluctuation was measured with computerised cognitive testing.

Results: 29 patients (mean age 63.4 years; disease duration 4.8 years, MDS UPDRS III 27.1) completed the study, with no significant differences for baseline clinical demographics between active (n=14) and sham (n=15) groups. There was an overall decrease in step time and step length variability in the active nVNS group, with the latter statistically significant compared with sham nVNS (% improvement +6.0 vs. -25.4%, p=0.045). No difference in cognitive testing was noted.

Conclusion: This small pilot study has shown that nVNS can improve gait parameters associated with dopa-resistant gait impairment in early PD. Non-invasive VNS therefore has the potential to provide a safe, low-cost therapy that can be delivered in the community. (Also presented at the Parkinson’s UK Research Conference, York, UK, 12th November 2018)

References: (1) Yarnall AJ, Rochester L, Burn DJ. Mov Dis 2011; 26: 2496-503. (2) Rochester L, Galna B, Lord S, Yarnall AJ, Morris R, Duncan G, Mollenhauer B, Burn DJ. Neur 2017; 88: 1501-11.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/non-invasive-vagus-nerve-stimulation-a-non-pharmacological-approach-to-target-gait-impairment-in-parkinsons-disease/