Freezing of Gait in Parkinson’s Disease Patients Treated with Bilateral Subthalamic Nucleus Deep Brain Stimulation: A Long-Term Overview

Abstract

Bilateral subthalamic nucleus deep brain stimulation (STN-DBS) is an effective treatment in advanced Parkinson’s Disease (PD). However, the effects of STN-DBS on freezing of gait (FOG) are still debated, particularly in the long-term follow-up (≥5-years). The main aim of the current study is to evaluate the long-term effects of STN-DBS on FOG. Twenty STN-DBS treated PD patients were included. Each patient was assessed before surgery through a detailed neurological evaluation, including FOG score, and revaluated in the long-term (median follow-up: 5-years) in different stimulation and drug conditions. In the long term follow-up, FOG score significantly worsened in the off-stimulation/off-medication condition compared with the pre-operative off-medication assessment (z = −1.930; p = 0.05) but not in the on-stimulation/off-medication (z = −0.357; p = 0.721). There was also a significant improvement of FOG at long-term assessment by comparing on-stimulation/off-medication and off-stimulation/off-medication conditions (z = −2.944; p = 0.003). These results highlight the possible beneficial long-term effects of STN-DBS on FOG.

Interplay between speech and gait variables in Parkinson's disease patients treated with subthalamic nucleus deep brain stimulation: A long‐term instrumental assessment

“…In this study we did not perform an instrumental assessment of FOG, this representing a limitations of the study; however, patients were assessed clinically with the FOG score [56]. In particular, we found in our cohort that PD progression led to a significant worsening of FOG, tested without any treatments, while bilateral STN‐DBS and levodopa were effective in controlling the worsening of FOG over time [56].…”

“…In this study we did not perform an instrumental assessment of FOG, this representing a limitations of the study; however, patients were assessed clinically with the FOG score [56]. In particular, we found in our cohort that PD progression led to a significant worsening of FOG, tested without any treatments, while bilateral STN‐DBS and levodopa were effective in controlling the worsening of FOG over time [56]. Furthermore, patients who experienced a long‐term worsening of FOG showed a greater preoperative motor disease severity and had a more severe axial impairment in all the postoperative conditions [56].…”

Longitudinal Neuropsychological Assessment of Symptomatic Edema after Subthalamic Nucleus Deep Brain Stimulation Surgery: A Case Series Study

“…All patients were evaluated before surgery in accordance with the Core Assessment Program for Surgical Interventional Therapies in Parkinson’s Disease (CAPSIT-PD) [ 18 ]. All patients also underwent a 3 Tesla brain MRI in order to evaluate the presence of significant white matter hyperintensities of vascular origin [ 4 ]. Moreover, all patients underwent a detailed neuropsychological assessment and were also screened for the presence of pathogenic variants in PD-associated genes [ 4 ].…”

“…All patients also underwent a 3 Tesla brain MRI in order to evaluate the presence of significant white matter hyperintensities of vascular origin [ 4 ]. Moreover, all patients underwent a detailed neuropsychological assessment and were also screened for the presence of pathogenic variants in PD-associated genes [ 4 ].…”

“…It has been widely shown that, compared to pharmacological treatment, STN-DBS is more effective in improving motor functions and the quality of life of patients with advanced PD, in both short- and long-term follow-up [ 1 , 2 , 3 ]. Particularly, in the long-term, STN-DBS allows a stable improvement of motor complications, tremor and rigidity but with a less relevant effect on axial symptoms (e.g., gait and balance symptoms, speech and swallowing troubles) and cognitive decline [ 4 , 5 ]. The most common surgical complications of STN-DBS include intracranial haemorrhages, electrodes malposition, infection, seizures and ischemic strokes [ 6 , 7 ].…”