Acute and Chronic Effects of Deep Brain Stimulation on Gait Kinematics in Patients with Parkinson’s Disease
jamal al ali1, J.Lucas Mckay1, Joe R. Nocera1, Faical Isbaine2, Julie T. Tran1, Paola Testini3, Shirley D. Triche1, Christine D. Esper1, Pratibha Aia1, Laura M. Scorr1, Lenora Higginbotham1, Richa Tripathi1, Svjetlana Miocinovic1, Cathrin Buetefisch1
1Neurology, 2Neurosurgery, Emory University, 3University of Utah
Objective:
To investigate the acute and chronic effects of deep brain stimulation (DBS) of the subthalamic nucleus (STN) or globus pallidus internus (GPi) on gait in patients with Parkinson’s disease (PD)
Background:
The effect of DBS on gait is variable. Few studies have followed patients longitudinally with quantitative gait kinematics. We hypothesize that STN and GPi DBS exert acute and chronic effects on gait
Design/Methods:
Gait kinematics were collected on PD patients implanted with STN or GPi DBS using a pressure sensitive walkway (Protokinetics Zeno). Patients were followed prospectively, and data were collected at baseline before initial DBS activation (n=104), acutely after activation (n=102), and chronically at 1 month (n=75) and 12 months (n=82). Multiple gait kinematic variables were analyzed longitudinally to account for gait domains including gait pace, variability, rhythm, asymmetry, and postural control
Results:
We report the longitudinal changes in gait velocity which is impaired (<100cm/s) in PD. At baseline, gait velocity mean was abnormally slow (80.6 cm/s). Velocity significantly increased acutely after DBS activation (97.9 cm/s), and the velocity improvement was maintained at 1 month (92 cm/s) and 12 months follow up (median 91.6 cm/s). The effect of bilateral STN stimulation on velocity was significantly greater than that of unilateral STN or GPi stimulation at 1 and 12 months. Individual-level analysis shows that of the patients with longitudinal follow up, 34% had clinically significant velocity improvement (>10cm/s), 51% had no change and 15% had worsening. The improvement was usually immediate (71%), while worsening was typically delayed (75%)
Conclusions:
DBS improves gait velocity immediately and the effect can be maintained chronically after 12 months. This effect may depend on the stimulation target and laterality. The rapid response suggests that improved gait velocity may be related to reduction of pathologic oscillatory neural activity while the delayed effects may involve reorganization of stimulated neuronal networks
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.