Effects of subthalamic nucleus stimulation and levodopa on freezing of gait in Parkinson disease

Ferraye, Murielle Ursulla; Debû, Bettina; Fraix, Valérie; Xie‐Brustolin, Jing; Chabardès, Stéphan; Krack, Paul; Benabid, A.L.; Pollak, Pierre

doi:10.1212/01.wnl.0000310416.90757.85

Cited by 112 publications

(76 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Also, it has been shown that STN stimulation can lead to gait worsening in some patients. Such an effect has mostly been reported after several years of STN stimulation [6] if not directly resulting from electrode misplacement. We controlled for such unwanted effect by checking electrode placement on the postoperative MRI and by verifying that the on stimulation scores were lower than the off stimulation scores on the objective gait item of the UPDRS III.…”

Section: Discussionmentioning

confidence: 97%

See 1 more Smart Citation

Levodopa-Resistant Freezing of Gait and Executive Dysfunction in Parkinson's Disease

et al. 2013

Self Cite

View full text Add to dashboard Cite

We examined executive functioning in patients with Parkinson's disease exhibiting, or not, levodopa-resistant freezing of gait (L-FOG). 38 advanced-stage patients with L-FOG were identified in a consecutive series of 400 patients. They were matched with 38 patients without L-FOG. All patients underwent prospective evaluations of cognitive and motor functioning before subthalamic nucleus surgery, and 1 year after. A composite frontal score, a measure of executive functioning, was compared between the two groups. We also examined correlations between the frontal score and the score on the FOG item of the Unified Parkinson Disease Rating Scale II. Results show that after surgery, patients with L-FOG, as a group, were more impaired in executive functioning than control patients. However, individual data analysis showed preserved executive functions in 11 patients with L-FOG. In addition, there was no correlation between L-FOG severity and the degree of executive impairment. Therefore, frontal dysfunction may be one mechanism underlying L-FOG in a number of patients with Parkinson's disease. However, since some patients develop L-FOG despite the preservation of executive functions, lesions or dysfunction of other neuronal structures are likely to be involved.

show abstract

Section: Discussionmentioning

confidence: 97%

“…Advanced stages of PD are dominated by axial symptoms including L-FOG [6] and postural instability, as well as executive dysfunction. In addition, gait difficulties have sometimes been reported after subthalamic nucleus (STN) surgery in patients with PD [6]. …”

Section: Introductionmentioning

confidence: 99%

Levodopa-Resistant Freezing of Gait and Executive Dysfunction in Parkinson's Disease

et al. 2013

Self Cite

View full text Add to dashboard Cite

show abstract

“…34 In contrast, other studies suggest a lesser efficacy of STN stimulation relative to L-dopa. 34, 40 Stolze et al 34 found that the improvement in stride length induced by STN stimulation was less marked than that induced by L-dopa. In addition, in a study involving a large consecutive series of patients with PD, Ferraye et al 40 analyzed a composite gait subscore (sum of items 13 ''walking'' and 14 ''freezing'' of the UPDRS Part II, and item 29 ''gait of the UPDRS Part III), the ability of the patients to perform the Stand Walk Sit Test and the frequency of FOG episodes before and after STN surgery.…”

Section: Comparison Of Levodopa and Stn Stimulation Effects On Gaitmentioning

confidence: 99%

“…34, 40 Stolze et al 34 found that the improvement in stride length induced by STN stimulation was less marked than that induced by L-dopa. In addition, in a study involving a large consecutive series of patients with PD, Ferraye et al 40 analyzed a composite gait subscore (sum of items 13 ''walking'' and 14 ''freezing'' of the UPDRS Part II, and item 29 ''gait of the UPDRS Part III), the ability of the patients to perform the Stand Walk Sit Test and the frequency of FOG episodes before and after STN surgery. Results showed that although most L-dopa-responsive gait impairments were well controlled either by L-dopa or by stimulation, in some cases there was a failure of stimulation to replicate the L-dopa-induced improvement.…”

Section: Comparison Of Levodopa and Stn Stimulation Effects On Gaitmentioning

confidence: 99%

See 1 more Smart Citation

Deep brain stimulation effect on freezing of gait

2008

View full text Add to dashboard Cite

The majority of patients with Parkinson's disease suffer from freezing of gait (FOG), which responds more or less to levodopa. Thalamic stimulation, mainly used in the treatment of tremor dominant Parkinson's disease is ineffective in FOG. GPi stimulation moderately improves FOG, but this effect may abate in the long term. STN stimulation was reported to improve levodopa-responsive FOG. In some patients, the benefit from levodopa is greater than that from STN stimulation, and levodopa and STN stimulation can have additive effects. On the contrary, STN stimulation is ineffective on levodopa-resistant FOG. In the few cases of levodopa-induced FOG, STN stimulation can indirectly be effective, thanks to a great decrease or arrest of levodopa. Stimulation of the pedunculopontine nucleus has recently been performed in small groups of patients suffering from both off- and on-levodopa gait impairments. The first results appear encouraging, but they need to be confirmed by controlled studies in larger series of patients.

show abstract

Directional Subthalamic Deep Brain Stimulation Better Improves Gait and Balance Disorders in Parkinson's Disease Patients: A Randomized Controlled Study

Cherif,

Tempier,

Yeche

et al. 2024

Annals of Neurology

View full text Add to dashboard Cite

ObjectiveTo investigate the effects of directional subthalamic deep brain stimulation (STN‐dDBS) on gait and balance disorders, including freezing of gait (FOG), in patients with advanced Parkinson's disease (PD).MethodsWe included 10 participants who underwent STN‐DBS and presented severe preoperative FOG, in a randomized, double‐blind, crossover study. We used segmented DBS electrodes to investigate whether directing the predicted volume of tissue activated (VTA) to overlap the central STN preferentially improved gait and balance disorders compared to directional DBS applied in the more posterior STN (sensorimotor). We also assessed non‐directional (ring‐mode) STN‐DBS. Our primary outcome was gait and balance control measured using instrumented gait recordings. Each patient had a pre‐operative structural and diffusion‐weighted imaging to model individual VTAs and to examine cortico‐subthalamic connectivity. We used linear mixed‐effects models to contrast the effects of central STN‐dDBS, posterior STN‐dDBS, and ring‐mode STN‐DBS.ResultsCentral STN‐dDBS produced significantly better improvement in gait and balance control compared to posterior STN‐dDBS (p = 0.027), with fewer FOG episodes (p < 0.001). Conversely, ring‐mode STN‐DBS resulted in worsened postural control compared to central STN‐dDBS (p = 0.009). The cortico‐subthalamic connectivity with the STN VTAs involved mostly primary sensorimotor, premotor, and medial frontal cortices, with a higher overall cortico‐STN connectivity with ring‐mode STN‐DBS.InterpretationCentral STN‐dDBS represents the best option to improve gait and balance disorders in PD patients, including FOG. Our findings raise the possibility of reprogramming STN‐DBS toward the central area in selected patients with disabling FOG and/or postural instability after surgery. ANN NEUROL 2024

show abstract

Effects of subthalamic nucleus stimulation and levodopa on freezing of gait in Parkinson disease

Abstract: Overall, subthalamic nucleus stimulation improved levodopa-responsive freezing of gait in most patients, although it was not always as effective as levodopa to improve gait impairments. In addition, surgery can induce gait problems in some patients.

Cited by 112 publications

References 31 publications

Levodopa-Resistant Freezing of Gait and Executive Dysfunction in Parkinson's Disease

Levodopa-Resistant Freezing of Gait and Executive Dysfunction in Parkinson's Disease

Deep brain stimulation effect on freezing of gait

Directional Subthalamic Deep Brain Stimulation Better Improves Gait and Balance Disorders in Parkinson's Disease Patients: A Randomized Controlled Study

Contact Info

Product

Resources

About