Short Pulse and Conventional Deep Brain Stimulation Equally Improve the Parkinsonian Gait Disorder

Article type: Research Article

Authors: Seger, Aline^{a; 1} | Gulberti, Alessandro^{a; b} | Vettorazzi, Eik^c | Braa, Hanna^a | Buhmann, Carsten^a | Gerloff, Christian^a | Hamel, Wolfgang^d | Moll, Christian K.E.^b | Pötter-Nerger, Monika^{a; *}

Affiliations: [a] Department of Neurology, Hamburg, University Medical Center Hamburg-Eppendorf, Germany | [b] Department of Neurophysiology and Pathophysiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany | [c] Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany | [d] Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

Correspondence: [*] Correspondence to: PD Dr. med. Monika Pötter-Nerger, Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg Eppendorf, Martinistr. 52, 20246 Hamburg, Germany. Tel.: +49 040 7410 18855; E-mail: m.poetter-nerger@uke.de.

Note: [1] Current Address: Department of Neurology, University Hospital Cologne, Cologne, Germany

Abstract: Background:Gait disturbances and balance remain challenging issues in Parkinsonian patients (PD) with deep brain stimulation (DBS). Short pulse deep brain stimulation (spDBS) increases the therapeutic window in PD patients, yet the effect on gait and postural symptoms remains unknown. Objective:We assessed the efficacy of spDBS compared to conventional DBS (cDBS) within the subthalamic nucleus (STN) on Parkinsonian gait. Methods:The study was a single-centre, randomized, double-blind, clinical short-term trial. 20 PD patients were studied postoperatively in three different conditions (DBS stimulation switched off (off DBS), spDBS with 40μs pulse width, cDBS with 60μs pulse width) on regular medication. The primary endpoint was the relative difference of gait velocity at self-paced speed during quantitative gait analysis between stimulation conditions. Secondary endpoints were changes of further measures of quantitative gait analysis, Ziegler course, Berg balance scale, FOG questionnaire, MDS-UPDRS, PDQ-39, and HADS. Mixed-model analysis and post-hoc t-tests were performed. Results:Both spDBS and cDBS improved gait velocity at self-paced speed compared to off DBS, however, there was no significant difference between both stimulation modes. Still, 40% of the patients preferred spDBS over cDBS subjectively. Both stimulation modes were equally effective in improving secondary endpoints of gait, balance, motor and non-motor performances. Conclusion:The use of spDBS and cDBS is equally effective in improving gait and balance in PD and might be beneficial in specified cohorts of PD patients.

Keywords: Deep brain stimulation, freezing of gait, gait disorder, Parkinson’s disease, short pulse width, subthalamic nucleus

DOI: 10.3233/JPD-202492

Journal: Journal of Parkinson's Disease, vol. 11, no. 3, pp. 1455-1464, 2021