Objective: To examine the effects of SCS on gait disturbance in PD patients with prior GPi-DBS.

Background: Previous studies have suggested the safety and efficacy of spinal cord stimulation (SCS) on gait disturbance in Parkinsonian (PD) patients with deep brain stimulation (DBS) of the subthalamic nucleus (STN). Globus pallidus interna (GPi) is widely accepted as a better target for severe gait problems than STN. However, the effects of SCS on gait disturbance in PD patients with GPi-DBS has not ever been considered.

Method: One PD patient (63 years old, female, diagnosed with PD in 2012 and underwent GPi-DBS in 2017) who experienced severe freezing of gait two years after GPi stimulation were treated with spinal cord stimulation at 45Hz. Surgical lead was implanted in the epidural space of the lower thoracic (T11-T12) spine. Gait impairments were measured using Timed-Up-Go (TUG) and motor dual task at baseline and one-month post-surgery.

Results: Compared to the total time spent at baseline, the patient with SCS had 47% improvement in TUG and 25% improvement in motor dual task in the off-medication state at 1-month follow-up. Meanwhile, the freezing episodes was reduced from 7 to 0 in TUG but increased from 13 to 15 in motor dual task in the off-medication state.

Conclusion: Lower thoracic (T11-T12) spinal cord stimulation at 45 Hz led to a significant improvement in gait velocity but not freezing episodes in PD patient with prior GPi-DBS.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/spinal-cord-stimulation-improves-gait-velocity-but-not-freezing-episodes-in-pd-patient-with-prior-gpi-dbs-a-case-report/