Long-term effect of subthalamic nucleus deep brain stimulation on freezing of gait in Parkinson’s disease

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OBJECTIVE

Subthalamic nucleus deep brain stimulation (STN DBS) is effective against freezing of gait (FOG) in Parkinson’s disease (PD); however, whether this effect persists over the long term is debated. The aim of the current study was to investigate the long-term effect of STN DBS on FOG in patients with PD.

METHODS

Data on 52 cases in which PD patients received bilateral STN DBS were obtained from a prospective registry. The authors blindly analyzed FOG incidence and its severity from the videotapes of a 5-m walking task at the baseline and at the 1-, 2-, and 5- or 7-year follow-up visits. They also compared the axial score from the Unified Parkinson’s Disease Rating Scale (UPDRS) part III, UPDRS part II (UPDRS-II) item 14, and the FOG questionnaire (FOG-Q). Postoperatively, video-based FOG analysis and the axial score were evaluated under 4 conditions (off-medication/off-stimulation, off-medication/on-stimulation, on-medication/off-stimulation, and on-medication/on-stimulation), and UPDRS-II item 14 and the FOG-Q score were evaluated under 2 conditions (off-medication/on-stimulation and on-medication/on-stimulation).

RESULTS

During the off-medication state, the on-stimulation condition improved FOG outcomes, except for video-based FOG severity, up to the last follow-up compared with the baseline. Video-based FOG outcomes and the axial score during the off-medication state were improved with the on-stimulation condition up to the last follow-up compared with the off-stimulation condition. During the on-medication state, the on-stimulation condition did not improve any FOG outcome compared with the baseline; however, it improved video-based FOG outcomes up to the 2-year follow-up and the axial score up to the last follow-up compared with the off-stimulation condition.

CONCLUSIONS

Our findings suggest that STN DBS has a long-term effect on FOG in the off-medication state. However, STN DBS did not show a long-term effect on FOG in the on-medication state, although it had a short-term effect until the 2-year follow-up.

ABBREVIATIONS DBS = deep brain stimulation; FOG = freezing of gait; FOG-Q = FOG questionnaire; GEE = generalized estimating equation; ICC = intraclass correlation coefficient; PD = Parkinson’s disease; SNUH = Seoul National University Hospital; STN = subthalamic nucleus; UPDRS = Unified Parkinson’s Disease Rating Scale; UPDRS-II = UPDRS part II; UPDRS-III = UPDRS part III.
Article Information

Contributor Notes

Correspondence Beomseok Jeon: College of Medicine, Seoul National University Hospital, Seoul, Korea. brain@snu.ac.kr.INCLUDE WHEN CITING Published online January 11, 2019; DOI: 10.3171/2018.8.JNS18350.Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
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