Affiliations: [a] University Medical Center Hamburg-Eppendorf, Department of Neurology, Hamburg, Germany
| [b] University Medical Center Hamburg-Eppendorf, Department of Neurophysiology and Pathophysiology, Hamburg, Germany
| [c] Institute of Medical Biometry and Epidemiology, Center for Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| [d] University Medical Center Hamburg-Eppendorf, Department of Neurosurgery, Hamburg, Germany
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: [email protected].
] Current Address: University Hospital Cologne, Department of Neurology, 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, nearly half 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