Left Vagus Stimulation Modulates Contralateral Subthalamic β Power Improving the Gait in Parkinson's Disease

Marano, Massimo; Anzini, Gaia; Saltarocchi, Luca; Ricciuti, Riccardo; Capone, Fioravante; Tan, Huiling; Torrecillos, Flavie; Lanzone, Jacopo; Di Lazzaro, Vincenzo

doi:10.1002/mds.29690

Movement Disorders

2023

DOI: 10.1002/mds.29690

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Left Vagus Stimulation Modulates Contralateral Subthalamic β Power Improving the Gait in Parkinson's Disease

Massimo Marano,

Gaia Anzini,

Luca Saltarocchi

et al.

Abstract: BackgroundTranscutaneous vagus nerve stimulation (VNS) showed early evidence of efficacy for the gait treatment of Parkinson's disease (PD).ObjectivesProviding data on neurophysiological and clinical effects of transauricular VNS (taVNS).MethodsTen patients with recording deep brain stimulation (DBS) have been enrolled in a within participant design pilot study, double‐blind crossover sham‐controlled trial of taVNS. Subthalamic local field potentials (β band power), Unified Parkinson's Disease Rating Scales (U… Show more

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Cited by 6 publications

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A Pragmatic Review on Spinal Cord Stimulation Therapy for Parkinson's Disease Gait Related Disorders: Gaps and Controversies

Hvingelby,

Carra,

Terkelsen

et al. 2024

Movement Disord Clin Pract

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BackgroundParkinson's Disease (PD) is a progressive neurological disorder that results in potentially debilitating mobility deficits. Recently, spinal cord stimulation (SCS) has been proposed as a novel therapy for PD gait disorders. The highest levels of evidence remain limited for SCS.ObjectivesIn this systematic review and narrative synthesis, the literature was searched using combinations of key phrases indicating spinal cord stimulation and PD.MethodsWe included pre‐clinical studies and all published clinical trials, case reports, conference abstracts as well as protocols for ongoing clinical trials. Additionally, we included trials of SCS applied to atypical parkinsonism.ResultsA total of 45 human studies and trials met the inclusion criteria. Based on the narrative synthesis, a number of knowledge gaps and future avenues of potential research were identified. This review demonstrated that evidence for SCS is currently not sufficient to recommend it as an evidence‐based therapy for PD related gait disorders. There remain challenges and significant barriers to widespread implementation, including issues regarding patient selection, effective outcome selection, stimulation location and mode, and in programming parameter optimization. Results of early randomized controlled trials are currently pending. SCS is prone to placebo, lessebo and nocebo as well as blinding effects which may impact interpretation of outcomes, particularly when studies are underpowered.ConclusionTherapies such as SCS may build on current evidence and be shown to improve specific gait features in PD. Early negative trials should be interpreted with caution, as more evidence will be required to develop effective methodologies in order to drive clinical outcomes.

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A Pragmatic Review on Spinal Cord Stimulation Therapy for Parkinson's Disease Gait Related Disorders: Gaps and Controversies

Hvingelby,

Carra,

Terkelsen

et al. 2024

Movement Disord Clin Pract

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The Effect of taVNS at 25 Hz and 100 Hz on Parkinson's Disease Gait—A Randomized Motion Sensor Study

van Midden,

Simončič,

Pirtošek

et al. 2024

Movement Disorders

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BackgroundTranscutaneous electrostimulation of the auricular branch of the vagal nerve (taVNS) has the propensity to reach diffuse neuromodulatory networks, which are dysfunctional in Parkinson's disease (PD). Previous studies support the use of taVNS as an add‐on treatment for gait in PD.ObjectivesWe assessed the effect of taVNS at 25 Hz (taVNS25), taVNS at 100 Hz (taVNS100), and sham earlobe stimulation (sVNS) on levodopa responsive (arm swing velocity, arm range of motion, stride length, gait speed) and non‐responsive gait characteristics (arm range of motion asymmetry, anticipatory postural adjustment [APA] duration, APA first step duration, APA first step range of motion), and turns (first turn duration, double 360° turn duration, steps per turn) in advanced PD.MethodsIn our double blind sham controlled within‐subject randomized trial, we included 30 PD patients (modified Hoehn and Yahr stage, 2.5–4) to assess the effect of taVNS25, taVNS100, and sVNS on gait characteristics measured with inertial motion sensors during the instrumented stand and walk test and a double 360° turn. Separate generalized mixed models were built for each gait characteristic.ResultsDuring taVNS100 compared to sVNS arm swing velocity (P = 0.030) and stride length increased (P = 0.027), and APA duration decreased (P = 0.050). During taVNS25 compared to sVNS stride length (P = 0.024) and gait speed (P = 0.021) increased and double 360° turn duration decreased (P = 0.039).ConclusionsWe have found that taVNS has a frequency specific propensity to improve stride length, arm swing velocity, and gait speed and double 360° turn duration in PD patients. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

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Vagus nerve stimulation in Parkinson’s disease: a scoping review of animal studies and human subjects research

Evancho,

Do,

Fortenberry

et al. 2024

npj Parkinsons Dis.

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Left Vagus Stimulation Modulates Contralateral Subthalamic β Power Improving the Gait in Parkinson's Disease

Cited by 6 publications

References 34 publications

A Pragmatic Review on Spinal Cord Stimulation Therapy for Parkinson's Disease Gait Related Disorders: Gaps and Controversies

A Pragmatic Review on Spinal Cord Stimulation Therapy for Parkinson's Disease Gait Related Disorders: Gaps and Controversies

The Effect of taVNS at 25 Hz and 100 Hz on Parkinson's Disease Gait—A Randomized Motion Sensor Study

Vagus nerve stimulation in Parkinson’s disease: a scoping review of animal studies and human subjects research

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