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Title: 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
Author: Valldeoriola Serra, Francesc
Muñoz, Esteban
Rumià, Jordi
Roldán, Pedro
Camara, Ana
Compta, Yaroslau
Martí Domènech, Ma. Josep
Tolosa, Eduardo
Keywords: Malaltia de Parkinson
Estimulació del cervell
Parkinson's disease
Brain stimulation
Issue Date: 1-Mar-2019
Publisher: Elsevier B.V.
Abstract: INTRODUCTION: 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. OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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
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It is part of: Parkinsonism & Related Disorders, 2019, vol. 60, p. 153-157
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ISSN: 1353-8020
Appears in Collections:Articles publicats en revistes (Medicina)

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