Objective: To investigate the acute and chronic effects of deep brain stimulation (DBS) of subthalamic nucleus (STN) or globus pallidus internus (GPi) on gait in patients with Parkinson’s disease (PD).

Background: DBS is highly effective for appendicular symptoms, but its effect on gait is variable. Few studies have followed patients longitudinally and most studies have focused on STN target so much less is known about the effect of GPi stimulation. Selection of effective DBS parameters for the treatment of gait in the clinical setting is challenged by several factors including the lack of sensitivity of the PD clinical rating scales in capturing DBS effects on gait. We hypothesize that STN and GPi DBS exert acute and chronic effects on gait depending on the target.

Method: Gait kinematics were collected on a pressure sensitive walkway (Protokinetics Zeno) in a prospective, longitudinal study to determine acute and chronic effects of STN and GPi DBS on gait velocity in PD. Gait velocity was selected as primary outcome measure because of its established clinical relevance. Gait velocity of < 100 cm/s indicates impaired walking and ±10 cm/s change is a clinically meaningful difference. Measurements were obtained before device activation (baseline), 5 minutes (acute) after the DBS activation, and again at 1 month (same settings; off medications) and 12 months (optimal DBS settings, off medication) after DBS activation.

Results: Here we report the results from data analysis for the acute and 1 month time point of 73 PD patients with STN or GPi DBS. At baseline, gait velocity was abnormally slow (median 88 cm/s). Velocity significantly increased acutely (median 100 cm/s) and was maintained after 1 month of DBS (median 99 cm/s). Acute improvement was observed in patients with bilateral STN or GPi stimulation, with sustained benefit in the STN group only. Unilateral DBS had no effect. Data collection for the 12 months’ time point is still ongoing.

Conclusion: DBS improves gait velocity immediately and was maintained after 1 month of chronic stimulation on the same settings. This effect may depend on the stimulation target and number of leads. The rapid response suggests that improved gait velocity may be related to reduction of pathologic oscillatory neural activity while the delayed effects may involve reorganization of stimulated neuronal networks.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/acute-and-chronic-effects-of-deep-brain-stimulation-on-gait-in-patients-with-parkinsons-disease/