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Review
. 2022 May 16:16:806513.
doi: 10.3389/fnhum.2022.806513. eCollection 2022.

Troubleshooting Gait Disturbances in Parkinson's Disease With Deep Brain Stimulation

Nicoló G Pozzi  1 , Chiara Palmisano  1 , Martin M Reich  1 , Philip Capetian  1 , Claudio Pacchetti  2 , Jens Volkmann  1 , Ioannis U Isaias  1   3
Affiliations
Review

Troubleshooting Gait Disturbances in Parkinson's Disease With Deep Brain Stimulation

Nicoló G Pozzi et al. Front Hum Neurosci. .

Abstract

Deep brain stimulation (DBS) of the subthalamic nucleus or the globus pallidus is an established treatment for Parkinson's disease (PD) that yields a marked and lasting improvement of motor symptoms. Yet, DBS benefit on gait disturbances in PD is still debated and can be a source of dissatisfaction and poor quality of life. Gait disturbances in PD encompass a variety of clinical manifestations and rely on different pathophysiological bases. While gait disturbances arising years after DBS surgery can be related to disease progression, early impairment of gait may be secondary to treatable causes and benefits from DBS reprogramming. In this review, we tackle the issue of gait disturbances in PD patients with DBS by discussing their neurophysiological basis, providing a detailed clinical characterization, and proposing a pragmatic programming approach to support their management.

Keywords: Parkinson’s disease; deep brain stimulation (DBS); freezing of gait (FOG); globus pallidus pars interna (GPi); pedunculopontine nucleus (PPN); subthalamic nucleus (STN).

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Conflict of interest statement

The 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
Gait disturbances in PD and possible troubleshooting with DBS. The main gait conditions (i.e., gait initiation, steady-state walking, gait adaptation and turning) are displayed. The top red panels list the most frequent pathological abnormalities occurring in PD patients in meds-off condition and assessed clinically or with a kinematic gait analysis. The green panels at the bottom list the adjustment in DBS programming and medications for troubleshooting the pathological changes of the different gait components. For steady-state, unperturbed linear walking, we addressed separately the possible adjustments in case of bradykinetic, dystonic, dyskinetic, or ataxic gait. APA, Anticipatory postural adjustments; FOG, freezing of gait; HSF, high frequency stimulation (i.e., >130 Hz); STN, subthalamic nucleus; GPi, Globus pallidus pars interna.
FIGURE 2
FIGURE 2
Freezing of gait and possible troubleshooting with DBS. The clinical subtypes of FOG are displayed in the top blue panel, namely: start hesitation, gait freezing and trembling in place. The green panels below report the stimulation and medication adjustments for troubleshooting the different forms of FOG and precisely: meds-off/pseudo-on FOG, meds-on FOG and L-Dopa resistant FOG. HSF, high frequency stimulation (i.e., >130 Hz); LSF, low frequency stimulation (i.e., <80 Hz); STN, subthalamic nucleus; GPi, Globus pallidus pars interna; SNr, Substatia Nigra pars reticulata; IL-IL, interleaved-interlinked (Karl et al., 2020).
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