Prediction of the effect of deep brain stimulation on gait freezing of Parkinson's disease. (June 2021)

• Record Type: Journal Article
• Authors: Gavriliuc, Olga; Paschen, Steffen; Andrusca, Alexandru; Schlenstedt, Christian; Deuschl, Günther
• Is Part Of: Parkinsonism & related disorders. Volume 87(2021)
• Page Start: 82
• Page End: 86
• Publication Date: 2021-06
• Subjects: Parkinson's disease -- Deep brain stimulation -- Freezing of gait -- Prediction; Parkinson's disease -- Periodicals; Movement disorders -- Periodicals; Movement Disorders -- Periodicals; Nerve Degeneration -- Periodicals; Nervous System Diseases -- Periodicals; Parkinson Disease -- Periodicals; Tremor -- Periodicals; Parkinson, Maladie de -- Périodiques; Parkinson's disease; 616.833
• DOI: 10.1016/j.parkreldis.2021.04.006
• Languages: English
• ISSNs: 1353-8020

Abstract

Abstract: Objective: The response of freezing of gait (FOG) to deep brain stimulation of the subthalamic nucleus (STN-DBS) is controversial and depends on many poorly controlled factors. On the other hand, a clinical predictor for the individual patient is needed to counsel the patient regarding this symptom. Methods: A cohort of 124 patients undergoing STN-DBS was evaluated based on the video-documented Levodopa test at baseline in the OFF- and ON-drug condition and postoperatively in the best condition (ON-drug/ON-stim) and the worst condition (OFF-drug/ON-stim). We compared the freezing item of the Unified Parkinson's disease rating scale (#14), the UPDRS III total score, and FOG severity rated during four provoking situations with regard to its predictive value. Results: We found 'FOG during the turning task' to be the best predictor with an ROC-value of 0.857 compared to 0.603 for the UPDRS Item 14 and 0.583 for the total UPDRS III. An improvement of 1 or 2 grades of the turning item during the preoperative levodopa test predicts an improvement during the worst condition postoperatively of 1 grade or more with an 80% probability. Conclusion: This FOG prediction test is simple and clinically useful. The test needs to be studied in a prospective study. Highlights: UPDRS item 14 and total UPDRS III are weak predictors for the freezing of gait response to DBS. Freezing of gait outcome can be best predicted from the turning task improvement during the preoperative levodopa-test. An improvement of the turning item during the preoperative levodopa test predicts a gain with an 80% probability.