Objective: To systematically investigate the acute (5 minutes) and chronic (1 month) effects of deep brain stimulation (DBS) of subthalamic nucleus (STN) and 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 less predictable. Here we hypothesize that STN and GPi DBS treatment exert acute and chronic effects on gait and that the effects are related to the location of the active contact in the targeted nucleus.

Method: Quantitative gait metrics were collected at initial DBS programming visit and at 1-month follow up using a pressure sensitive walkway (Protokinetics Zeno). Measurements were obtained before device activation, after 5 minutes of DBS and after 1 month of DBS (same settings; off medications). Gait velocity during straight walking was the primary outcome. Patient-specific computational models were constructed in Lead-DBS to determine active contact location. Repeated measures ANOVA was applied.

Results: We evaluated gait velocity in 16 PD patients (11M/5W, 66±8 y/o, 6 STN, 10 GPi). Two were non-ambulatory, so 14 were included in the analysis. Average velocity (mean±sd) was 70±30 cm/sec before device activation (baseline), 90±34 cm/sec with acute stimulation and 80±27 cm/sec after 1 month of chronic stimulation. Velocity with acute stimulation was significantly higher compared to baseline (p=0.015). While it remained higher at the 1-month compared to baseline, this was not significant. At individual level, DBS activation resulted in immediate clinically meaningful improvement (>5 cm/sec) in 12/14 patients. In 6/12, this improvement was sustained at 1 month, while 5/12 returned to pre-activation baseline and 1/12 worsened. Two patients who had no initial effect, improved at 1-month follow up. In this preliminary cohort, there was no effect of target or active contact distance from the nucleus center on gait velocity.

Conclusion: Gait velocity increased within minutes of DBS initiation in most patients while some required longer stimulation. The rapid improvement is consistent with reduction of pathologic beta-band neural activity although placebo effect cannot be excluded. Sustained improvement may require reorganization of underlying neuronal networks which was not observed in all patients, possibly due to suboptimal stimulation settings early on.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/deep-brain-stimulation-improves-gait-velocity-acutely-in-patients-with-parkinsons-disease/