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. 2022 Mar 28:16:788200.
doi: 10.3389/fnhum.2022.788200. eCollection 2022.

Subthalamic Deep Brain Stimulation Lead Asymmetry Impacts the Parkinsonian Gait Disorder

Frederik P Schott  1 , Alessandro Gulberti  1   2 , Hans O Pinnschmidt  3 , Christian Gerloff  1 , Christian K E Moll  2 , Miriam Schaper  4 , Johannes A Koeppen  4 , Wolfgang Hamel  4 , Monika Pötter-Nerger  1
Affiliations

Subthalamic Deep Brain Stimulation Lead Asymmetry Impacts the Parkinsonian Gait Disorder

Frederik P Schott et al. Front Hum Neurosci. .

Abstract

Background: The preferable position of Deep Brain Stimulation (DBS) electrodes is proposed to be located in the dorsolateral subthalamic nucleus (STN) to improve general motor performance. The optimal DBS electrode localization for the post-operative improvement of balance and gait is unknown.

Methods: In this single-center, retrospective analyses, 66 Parkinson's disease (PD) patients (24 female, age 63 ± 7 years) were assessed pre- and post-operatively (8.45 ± 4.2 months after surgery) by using MDS-UPDRS, freezing of gait (FoG) score, Giladi's gait and falls questionnaire and Berg balance scale. The clinical outcome was related to the DBS electrode coordinates in x, y, z plane as revealed by image-based reconstruction (SureTune™). Binomial generalized linear mixed models with fixed-effect variables electrode asymmetry, parkinsonian subtype, medication, age class and clinical DBS induced changes were analyzed.

Results: Subthalamic nucleus-deep brain stimulation improved all motor, balance and FoG scores in MED OFF condition, however there were heterogeneous results in MED ON condition. DBS electrode reconstructed coordinates impacted the responsiveness of axial symptoms. FoG and balance responders showed slightly more medially located STN electrode coordinates and less medio-lateral asymmetry of the electrode reconstructed coordinates across hemispheres compared to non-responders.

Conclusion: Deep brain stimulation electrode reconstructed coordinates, particularly electrode asymmetry on the medio-lateral axis affected the post-operative responsiveness of balance and FoG symptoms in PD patients.

Keywords: Parkinson’s disease; balance; deep brain stimulation; electrode localization; freezing of gait; gait disorder; lead asymmetry; subthalamic nucleus.

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Conflict of interest statement

AG, CM, and WH had occasionally been reimbursed for travel expenses from Medtronic Inc. CG reported personal fees and other from Bayer Healthcare and Boehringer Ingelheim, personal fees from Abbott, Amgen, BMS, Sanofi Aventis, and Prediction Biosciences. CM received lecture, teaching, and proctoring fees from Abbott. WH received lecture fees and honoraria for serving on advisory boards and travel grants from Boston Scientific, Medtronic, and Abbott. MP-N received lecture fees from Abbott and Licher, and served as consultant for Medtronic, Boston Scientific, and Abbvie. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Methodological approach of electrode localization within the SureTune™ software. After definition of the AC-PC line in the axial and sagittal plane in the merged CT and MRI images, determination of spatial parameters of electrode localization was performed (A). Definition of active contact and modeling of volume of tissue activated by using corresponding stimulation parameters (B).
FIGURE 2
FIGURE 2
Relation of freezing of gait (FoG) and balance improvement to pre-operative symptom severity. FoG (A) and Berg balance (B) scores as recorded before and after subthalamic nucleus (STN)-deep brain stimulation (DBS) surgery. The pre-operative scores were recorded in the MED OFF condition, the post-operative scores were recorded in STIM ON/MED OFF condition. Values inset of Spearman correlation and best fit lines are given.
FIGURE 3
FIGURE 3
Relation of post-operative freezing of gait (FoG) and balance outcome to deep brain stimulation (DBS) electrode reconstructed coordinates. Panels (A,B) show the box plots of the patients subdivided into two groups depending on the responsiveness to the subthalamic nucleus (STN)-DBS treatment. If the difference between the post-operative scores minus the pre-operative scores was negative in case of FoG and positive in case of the Berg balance, indicating a post-operative improvement of the scores, the patients were assigned to the responder group, otherwise to the non-responder group. P-values reported in panels (A,B) refer to the results of the general linear mixed models.
See this image and copyright information in PMC

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