Factors correlated with therapeutic effects of globus pallidus deep brain stimulation on freezing of gait in advanced Parkinson's disease: A pilot study. (January 2022)

• Record Type: Journal Article
• Authors: Lee, Seung Hyun; Lee, Jooyoung; Kim, Mi Sun; Hwang, Yun Su; Jo, Sungyang; Park, Kye Won; Jeon, Sang Ryong; Chung, Sun Ju
• Is Part Of: Parkinsonism & related disorders. Volume 94(2022)
• Page Start: 111
• Page End: 116
• Publication Date: 2022-01
• Subjects: Parkinson's disease -- Deep brain stimulation -- Globus pallidus -- Dopamine transporter imaging -- Freezing of gait; 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.2021.12.005
• Languages: English
• ISSNs: 1353-8020

Abstract

Abstract: Introduction: Deep brain stimulation (DBS) has showed variable therapeutic effect on freezing of gait (FOG) in Parkinson's disease (PD). It is unclear which factors associated with the effect of DBS on FOG in patients with advanced PD. In this study, we investigated the correlation of pre and postoperative factors with the therapeutic effect of globus pallidus interna (GPi) DBS on FOG in PD patients. Methods: We retrospectively analyzed PD patients with FOG (N = 20) who underwent GPi DBS surgery. Postoperatively, video-based analysis for FOG severity was performed at the first DBS programming and patients were categorized into two groups according to DBS effect on FOG (11 FOG responders and 9 FOG non-responders) at medication-off state. We analyzed preoperative clinical characteristics, cognitive function, striatal dopamine transporter availability, postoperative DBS programming parameters, lead locations, and volume of tissue activated in functional subregions of GPi. Bootstrap enhanced Elastic-Net logistic regression was used to select pre and postoperative factors associated with the effect of GPi DBS. Results: Therapeutic effect of GPi DBS on FOG were correlated with the disease duration of PD before DBS surgery, preoperative improvement in FOG severity by levodopa medication, and the distance from active contact of DBS electrode to the prefrontal region of GPi anatomical site. Conclusions: Our study results suggest that the effect of GPi DBS on FOG is correlated with disease duration, levodopa responsiveness on FOG before DBS surgery and DBS electrode location, providing useful information to predict FOG outcome after GPi DBS in PD patients. Highlights: The factors influencing the effects of DBS on FOG in PD remain undetermined. Correlation between pre and postoperative factors and the effects of GPi DBS on FOG were investigated. Improvement in FOG after GPi DBS was correlated with shorter disease duration and higher levodopa responsiveness on FOG. Close distance from active contact to the GPi prefrontal subregion was correlated with a positive effect on FOG. GPi DBS may provide synergistic effects on levodopa outcomes on FOG.