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.
Aged
Cross-Over Studies
Deep Brain Stimulation
/ methods
Dopamine Agents
/ pharmacology
Female
Follow-Up Studies
Gait Disorders, Neurologic
/ drug therapy
Humans
Levodopa
/ pharmacology
Male
Middle Aged
Outcome and Process Assessment, Health Care
Parkinson Disease
/ complications
Pilot Projects
Single-Blind Method
Substantia Nigra
Subthalamic Nucleus
Freezing of gait
Low frequency stimulation
Parkinson's disease
Substantia nigra reticulata
Journal
Parkinsonism & related disorders
ISSN: 1873-5126
Titre abrégé: Parkinsonism Relat Disord
Pays: England
ID NLM: 9513583
Informations de publication
Date de publication:
03 2019
03 2019
Historique:
received:
31
05
2018
revised:
04
09
2018
accepted:
04
09
2018
pubmed:
23
9
2018
medline:
6
5
2020
entrez:
23
9
2018
Statut:
ppublish
Résumé
Experimental studies suggest that low-frequency (LF) (63 Hz) deep brain stimulation (DBS) of the substantia nigra pars reticulata (SNr) could be useful to regulate gait disorders refractory to medical treatment in Parkinson's disease (PD). The SNr neurons could act as high-frequency (HF) pacemakers within locomotor control systems. Currently, no specific therapies can treat gait disorders in PD with insufficient response to dopaminergic treatment. To investigate whether LF-SNr-DBS combined with standard HF stimulation of the subthalamic nucleus (STN) is clinically relevant in improving gait disorders that no longer respond to levodopa in PD patients, compared with HF-STN or LF-SNr stimulation alone. Patients received LF-SNr or HF-STN stimulation alone or combined (COMB) stimulation of both nuclei (crossover design). The nucleus to be stimulated was randomly assigned and clinical evaluations performed by a blinded examiner after three months follow-up for each. Clinical assessment included the Freezing of Gait questionnaire, Tinetti Balance and Walking Assessing tool, and Unified Parkinson's Disease Rating. We included six patients (mean age 59.1 years, disease duration 16.1 years). All patients suffered motor fluctuations and dyskinesias. The best results were obtained with COMB in four patients (who preferred and remained with COMB over 3 years of follow-up) and with HF-STN in two patients. SNr stimulation alone did not produce better results than COMB or STN in any patient. COMB and HF-STN stimulation improved PD-associated gait disorders in this preliminary case series, sustained over time. Further multicenter investigations are required to better explore this therapeutic option.
Identifiants
pubmed: 30241951
pii: S1353-8020(18)30393-6
doi: 10.1016/j.parkreldis.2018.09.008
pii:
doi:
Substances chimiques
Dopamine Agents
0
Levodopa
46627O600J
Types de publication
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
153-157Commentaires et corrections
Type : CommentIn
Type : CommentIn
Informations de copyright
Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.