Deep Brain Stimulation for Freezing of Gait in Parkinson's Disease With Early Motor Complications

Michael T Barbe¹, Lisa Tonder², Paul Krack³, Bettina Debû⁴, Michael Schüpbach^{3

5

6}, Steffen Paschen⁷, Till A Dembek¹, Andrea A Kühn⁸, Valerie Fraix^{4

9}, Christine Brefel-Courbon¹⁰, Lars Wojtecki¹¹, David Maltête¹², Phillippe Damier¹³, Friederike Sixel-Döring¹⁴, Daniel Weiss¹⁵, Marcus Pinsker¹⁶, Tatiana Witjas¹⁷, Stephane Thobois¹⁸, Carmen Schade-Brittinger¹⁹, Jörn Rau¹⁹, Jean-Luc Houeto²⁰, Andreas Hartmann⁵, Lars Timmermann^{1

21}, Alfons Schnitzler¹¹, Valerie Stoker², Marie Vidailhet²², Günther Deuschl⁷; EARLYSTIM study group

Affiliations

¹ Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
² Medtronic, Minneapolis, Minnesota, USA.
³ Department of Neurology, University Hospital Bern and University of Bern, Bern, Switzerland.
⁴ Université Grenoble Alpes, INSERM 1216, Grenoble Institut Neurosciences, Grenoble, France; Neurology Department, Grenoble University Hospital, Grenoble, France.
⁵ Assistance-Publique Hôpitaux de Paris; Centre d'Investigation Clinique 9503, Institut du Cerveau et de la Moelle épinière; Département de Neurologie, Université Pierre et Marie Curie-Paris 6 et INSERM, CHU Pitié-Salpêtrière, Paris, France.
⁶ Institute of Neurology, Konolfingen, Switzerland.
⁷ Department of Neurology, UKSH, Kiel Campus Christian-Albrechts-University, Kiel, Germany.
⁸ Department of Neurology, Charité-Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany.
⁹ Neurology Department, Grenoble University Hospital, Grenoble, France.
¹⁰ Department of Neurology, INSERM Unite 1214, University Hospital Toulouse, France.
¹¹ Institute of Clinical Neuroscience and Medical Psychology, and Department of Neurology, Heinrich-Heine University Duesseldorf, Duesseldorf, Germany.
¹² Department of Neurology, Rouen University Hospital and University of Rouen, Rouen, France; INSERM U1239, Laboratory of Neuronal and Neuroendocrine Differentiation and Communication, Mont-Saint-Aignan, France.
¹³ CHU Nantes, INSERM, CIC1413, Hôpital Laënnec, Nantes, France.
¹⁴ Paracelsus-Elena-Klinik Kassel, Kassel, Germany.
¹⁵ Centre of Neurology, Department for Neurodegenerative Diseases, and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.
¹⁶ Division of Stereotactic and Functional Neurosurgery, University Medical Center, Freiburg, Freiburg, Germany.
¹⁷ Department of Neurology, Timone University Hospital, UMR 7289, CNRS Marseille, Marseille, France.
¹⁸ Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Centre Expert Parkinson, Bron, France; Université Lyon, Université Claude Bernard Lyon 1, Faculté de Médecine Lyon Sud Charles Mérieux, Oullins, France.
¹⁹ The Coordinating Center for Clinical Trials, Philipps University, Marburg, Germany.
²⁰ Department of Neurology, CIC-INSERM 1402, CHU of Poitiers, University of Poitiers, Poitiers, France.
²¹ Universitätsklinikum Giessen und Marburg, Marburg Campus, Marburg, Germany.
²² Sorbonne Université, ICM UMR1127, INSERM &1127, CNRS 7225, Department of Neurology, Salpêtriere University Hospital, AP-HP, Paris, France.

PMID: 31755599
DOI: 10.1002/mds.27892

Deep Brain Stimulation for Freezing of Gait in Parkinson's Disease With Early Motor Complications

Michael T Barbe et al. Mov Disord. 2020 Jan.

. 2020 Jan;35(1):82-90.

doi: 10.1002/mds.27892. Epub 2019 Nov 22.

Authors

Affiliations

¹ Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
² Medtronic, Minneapolis, Minnesota, USA.
³ Department of Neurology, University Hospital Bern and University of Bern, Bern, Switzerland.
⁴ Université Grenoble Alpes, INSERM 1216, Grenoble Institut Neurosciences, Grenoble, France; Neurology Department, Grenoble University Hospital, Grenoble, France.
⁵ Assistance-Publique Hôpitaux de Paris; Centre d'Investigation Clinique 9503, Institut du Cerveau et de la Moelle épinière; Département de Neurologie, Université Pierre et Marie Curie-Paris 6 et INSERM, CHU Pitié-Salpêtrière, Paris, France.
⁶ Institute of Neurology, Konolfingen, Switzerland.
⁷ Department of Neurology, UKSH, Kiel Campus Christian-Albrechts-University, Kiel, Germany.
⁸ Department of Neurology, Charité-Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany.
⁹ Neurology Department, Grenoble University Hospital, Grenoble, France.
¹⁰ Department of Neurology, INSERM Unite 1214, University Hospital Toulouse, France.
¹¹ Institute of Clinical Neuroscience and Medical Psychology, and Department of Neurology, Heinrich-Heine University Duesseldorf, Duesseldorf, Germany.
¹² Department of Neurology, Rouen University Hospital and University of Rouen, Rouen, France; INSERM U1239, Laboratory of Neuronal and Neuroendocrine Differentiation and Communication, Mont-Saint-Aignan, France.
¹³ CHU Nantes, INSERM, CIC1413, Hôpital Laënnec, Nantes, France.
¹⁴ Paracelsus-Elena-Klinik Kassel, Kassel, Germany.
¹⁵ Centre of Neurology, Department for Neurodegenerative Diseases, and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.
¹⁶ Division of Stereotactic and Functional Neurosurgery, University Medical Center, Freiburg, Freiburg, Germany.
¹⁷ Department of Neurology, Timone University Hospital, UMR 7289, CNRS Marseille, Marseille, France.
¹⁸ Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Centre Expert Parkinson, Bron, France; Université Lyon, Université Claude Bernard Lyon 1, Faculté de Médecine Lyon Sud Charles Mérieux, Oullins, France.
¹⁹ The Coordinating Center for Clinical Trials, Philipps University, Marburg, Germany.
²⁰ Department of Neurology, CIC-INSERM 1402, CHU of Poitiers, University of Poitiers, Poitiers, France.
²¹ Universitätsklinikum Giessen und Marburg, Marburg Campus, Marburg, Germany.
²² Sorbonne Université, ICM UMR1127, INSERM &1127, CNRS 7225, Department of Neurology, Salpêtriere University Hospital, AP-HP, Paris, France.

PMID: 31755599
DOI: 10.1002/mds.27892

Abstract

Background: Effects of DBS on freezing of gait and other axial signs in PD patients are unclear.

Objective: Secondary analysis to assess whether DBS affects these symptoms within a large randomized controlled trial comparing DBS of the STN combined with best medical treatment and best medical treatment alone in patients with early motor complications (EARLYSTIM-trial).

Methods: One hundred twenty-four patients were randomized in the stimulation group and 127 patients in the best medical treatment group. Presence of freezing of gait was assessed in the worst condition based on item-14 of the UPDRS-II at baseline and follow-up. The posture, instability, and gait-difficulty subscore of the UPDRS-III, and a gait test including quantification of freezing of gait and number of steps, were performed in both medication-off and medication-on conditions.

Results: Fifty-two percent in both groups had freezing of gait at baseline based on UPDRS-II. This proportion decreased in the stimulation group to 34%, but did not change in the best medical treatment group at 24 months (P = 0.018). The steps needed to complete the gait test decreased in the stimulation group and was superior to the best medical treatment group (P = 0.016). The axial signs improved in the stimulation group compared to the best medical treatment group (P < 0.01) in both medication-off and medication-on conditions.

Conclusions: Within the first 2 years of DBS, freezing of gait and other axial signs improved in the medication-off condition compared to best medical treatment in these patients. © 2019 International Parkinson and Movement Disorder Society.

Keywords: EARLYSTIM; axial signs; deep brain stimulation; freezing of gait.

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References

1. Deuschl G, Schade-Brittinger C, Krack P, et al. A randomized trial of deep-brain stimulation for Parkinson's disease. N Engl J Med 2006;355(9):896-908.
1. Fasano A, Aquino CC, Krauss JK, Honey CR, Bloem BR. Axial disability and deep brain stimulation in patients with Parkinson disease. Nat Rev Neurol 2015;11:98-110.
1. Nutt JG, Bloem BR, Giladi N, Hallett M, Horak FB, Nieuwboer A. Freezing of gait: moving forward on a mysterious clinical phenomenon. Lancet Neurol 2011;10:734-744.
1. Latt MD, Lord SR, Morris JG, Fung VS. Clinical and physiological assessments for elucidating falls risk in Parkinson's disease. Mov Disord 2009;24:1280-1289.
1. Moore O, Peretz C, Giladi N. Freezing of gait affects quality of life of peoples with Parkinson's disease beyond its relationships with mobility and gait. Mov Disord 2007;22:2192-2195.

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Deep Brain Stimulation for Freezing of Gait in Parkinson's Disease With Early Motor Complications

Affiliations

Deep Brain Stimulation for Freezing of Gait in Parkinson's Disease With Early Motor Complications

Authors

Affiliations

Abstract

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

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Medical