July 23, 2019
About a third of patients with Parkinson disease experienced improvements in freezing of gait and falls after receiving subthalamic deep brain stimulation, according to a study published in the journal Parkinsonism & Related Disorders.
“Freezing of gait and falls are the most disabling motor symptoms in Parkinson's disease patients,” researchers explained. “The effects of subthalamic deep brain stimulation on freezing of gait and falls are still a matter of controversy, and factors contributing to their outcome have yet to be defined.”
This study looked at freezing of gait and falls after subthalamic deep brain stimulation in 331 patients with Parkinson’s disease. Magnetic resonance imaging (MRI) voxel-based morphometry (VBM) analysis was used for 151 patients.
Freezing of gait and falls decreased after subthalamic deep brain stimulation in approximately one-third of patients, researchers reported, with the best effects occurring when electrodes were located within the subthalamic nucleus.
Aggravation of freezing of gait, however, occurred in 93 patients and falls in 75 patients after surgery. Aggravation was not related to electrode location within the subthalamic nucleus.
The severity of gait freezing after subthalamic deep brain stimulation was associated with preoperative severity and putamen atrophy, the study found. Postprocedure severity of falls was linked with lower cognitive performance and postcentral gyrus atrophy.
“Clinicians should be aware that, after subthalamic deep brain stimulation, freezing of gait severity is related to preoperative freezing of gait severity whatever its dopa-sensitivity; and falls to lower postoperative cognitive performance; and atrophy of cortico-subcortical brain areas,” researchers wrote.
Karachi C, Cormier-Dequaire F, Grabli D, et al. Clinical and anatomical predictors for freezing of gait and falls after subthalamic deep brain stimulation in Parkinson's disease patients. Parkinson & Relat Disord. 2019;62:91-97.