Objective: To find out the evolution of freezing of gait (FoG) in Parkinson’s disease (PD) patients who underwent subthalamic nucleus deep brain stimulation (STN-DBS).

Background: PDP patients suffering gait disorders, mostly FoG, are at first, bad candidates for DBS. FoG is a common and disabling motor symptom that has a considerable impact on patients’ quality of life and so, represent an important therapeutic challenge. There is increasing evidence that SNT-DBS and several programming strategies may improve gait disorders in PD.

Method: 62 PD patients who underwent DBS were classified in five groups, according to the response of FoG to dopaminergic medication previously to surgery: (1) full response, (2) partial but satisfactory response, (3) no response, (4) FoG in ON medication, (5) patients who underwent previous DBS but developed FOG as part of evolution of PD. Patients were followed up after DBS, and the presence of FoG was evaluated with FOG questionnaire and Up&Go test. After surgery, the first approach consisted of conventional programming set at 60mcs and 130Hz. When there was no satisfactory response of FoG, alternative programming with low frequency stimulation of STN (40-80Hz) or combined stimulation (STN and Substantia nigra reticulata) was tested.

Results: 77% of patients who underwent DBS suffered FoG before surgery and 60% had full response to medication. No patients from group 3 were operated. After DBS surgery, 64,5% of freezers presented a good response to conventional stimulation, 22,9% responded to low frequencies and 8,3% to combined stimulation. 4% had no response or worsened after DBS.

Conclusion: More than half of patients with FoG improved with conventional DBS parameters. In addition, up to 27% more could be rescued by non-conventional paradigms of DBS programming.

References: 1. Schlenstedt C, Shalash A, Muthuraman M, Falk D, Witt K, Deuschl G. Effect of high-frequency subthalamic neurostimulation on gait and freezing of gait in Parkinson’s disease: a systematic review and meta-analysis. Eur J Neurol 2017;24(1):18-26. 2. Moreau C, Defebvre L, Destée A, Bleuse S, Clement F, Blatt JL, et al. STN-DBS frequency effects on freezing of gait in advanced Parkinson disease. Neurology 2008;71(2):80-4. 3. Valldeoriola F, Muñoz E, Rumià J, Roldán P, Cámara A, Compta Y, et al. Simultaneous low-frequency deep brain stimulation of the substantia nigra pars reticulata and high-frequency stimulation of the subthalamic nucleus to treat levodopa unresponsive freezing of gait in Parkinson’s disease: A pilot study. Parkinsonism Relat Disord 2019;60:153-7.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/evolution-of-freezing-of-gait-in-subthalamic-nucleus-deep-brain-stimulation/