Objective: Freezing of gait (FOG) is a common gait disorder in Parkinson’s disease (PD). In this study, we will adjust programming for patients with FOG after subthalamic nucleus deep brain stimulation (STN-DBS) to achieving satisfactory benefits.

Background: FOG often leads falls and less of life quality. It is estimated to affect over half of patients with advanced PD. STN-DBS is an effective treatment, but finding the effective programming strategy to maximize symptom control FOG while decreasing adverse effects is difficult.

Methods: We collected patients who received STN-DBS in our hospital during 2014 -2015 and patients suffered FOG before surgery. A monopolar and high frequency programming(conventional programming) was carried out for at the initial programming visit (set pulse width at 60 us and rate at 130Hz), amplitude and pulse width can be gradually increased as necessary. If conventional programming had proven ineffective, we will try low frequency (set rate at 60-90Hz). If low frequency programming had proven effective,but not remained or intolerable, then we will try alternate use low and high frequency or use interleaving stimulation. At the same time Unified Parkinson Disease Rating Scale motor (UPDRS-motor) score was performed before and after programming changed.

Results: There were eight patients enrolled. The mean age at the time of DBS surgery was 65±5.3 years. The mean duration between identification of Parkinsonian symptoms and DBS surgery was 8±3.7 years. (1) FOG significant improvements were observed in two patients for conventional programming. (2)The conventional programming was carried out for four patients at frist, amplitude and pulse width gradually increased, tremor and rigidity improved, but not FOG. Then we tried low frequency, tremor deteriorated at half a month in a patient, low frequency programming didn’t provide any improvement in the other three patients, the four patients showed improvement after switching to interleaving stimulation. (3) High frequency (rate at 130Hz) and low frequency (rate at 90Hz) both improved in the remaining two patients, but clinical benefits sustain less one month, with improvement after switching to alternate use low and high frequency every month. Patients showed satisfactory improvement in FOG and Unified PD Rating Scale motor scores.

Conclusions: We report our experience of eight PD patients using different programming strategy to improve FOG after STN-DBS, it suggests STN-DBS is recommended to treatment FOG.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/programming-for-freezing-of-gait-after-bilateral-subthalamic-nucleus-deep-brain-stimulation-for-parkinsons-disease/