Deep brain stimulation improves gait velocity in Parkinson’s disease: a systematic review and meta-analysis

Abstract

In Parkinson's disease (PD), slow gait speed is significantly related to clinical ratings of disease severity, impaired performance of daily activities, as well as increased overall disability. Conducting a meta-analysis on gait speed is an objective and quantitative technique to summarize the effectiveness of DBS and to determine the effect sizes for future studies. We conducted a systematic review and meta-analysis that analyzed the effects of deep brain stimulation (DBS) surgery on gait speed in patients with PD to gain fundamental insight into the nature of therapeutic effectiveness. A random effects model meta-analysis on 27 studies revealed a significant overall standardized mean difference medium effect size equal to 0.60 (SE = 0.06; p < 0.0001; Z = 10.58). Based on our synthesis of the 27 studies, we determined the following: (1) a significant and medium effect size indicating DBS improves gait speed; (2) DBS improved gait speed regardless of whether the patients were tested in the on or off medication state; (3) both bilateral and unilateral DBS led to gait speed improvement; (4) the effects of DBS on gait speed in the data collection sessions after surgery (DBS on vs. off) were comparable with data collection before surgery (before surgery vs. DBS after surgery); and (5) when evaluating the effects of DBS and medication on gait speed suprathreshold doses were comparable to normal dosages of medication and DBS. The current analysis provides objective evidence that both unilateral and bilateral DBS provide a therapeutic benefit on gait speed in persons with PD.

In vitro assessment of the differences in retinal ganglion cell responses to intra- and extracellular electrical stimulation

“…Electrical stimulation is used to treat patients with Parkinson's disease [23], to stop seizure spread [7], and to replace lost sensory functions in patients with loss of vision and hearing [3], [8], [31]. Optimal stimulation parameters are almost always patient specific.…”

Effects of Subthalamic and Nigral Stimulation on Gait Kinematics in Parkinson’s Disease

“…Standard deep brain stimulation of the subthalamic nucleus (STN-DBS) may improve gait in Parkinson’s disease (PD) with interindividual variability ( 1 , 2 ). STN-DBS was shown to modulate the spatial- and spatiotemporal parameters (e.g., step length, step velocity), however, the pure temporal parameters (e.g., step time) were less amenable to STN-DBS ( 3 – 5 ) and possibly more dependent on contributions from the mesencephalic locomotor region (MLR) along previous findings ( 6 , 7 ).…”

Effects of subthalamic and nigral stimulation on gait kinematics in Parkinson's disease

“…These results suggest that SNr stimulation might support temporal regularization of gait integration. (1,2). STN-DBS was shown to modulate the spatial-and spatiotemporal parameters (e.g., step length, step velocity), however, the pure temporal parameters (e.g., step time) were less amenable to STN-DBS (3)(4)(5) contributions from the mesencephalic locomotor region (MLR) along previous findings (6,7).…”