Spinal cord stimulation improves gait in patients with Parkinson's disease previously treated with deep brain stimulation

Movement DisordersVolume 32, Issue 2 p. 278-282 Brief Report Spinal cord stimulation improves gait in patients with Parkinson's disease previously treated with deep brain stimulation Carolina Pinto de Souza MD, Carolina Pinto de Souza MD Division of Functional Neurosurgery of Institute of Psychiatry, Department of Neurology, University of São Paulo Medical School, São Paulo, BrazilSearch for more papers by this authorClement Hamani MD, PhD, Clement Hamani MD, PhD Division of Functional Neurosurgery of Institute of Psychiatry, Department of Neurology, University of São Paulo Medical School, São Paulo, BrazilSearch for more papers by this authorCarolina Oliveira Souza PhD, Carolina Oliveira Souza PhD Division of Functional Neurosurgery of Institute of Psychiatry, Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil Movement Disorders Section, Department of Neurology, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, BrazilSearch for more papers by this authorWilliam Omar Lopez Contreras MD, PhD, William Omar Lopez Contreras MD, PhD Division of Functional Neurosurgery of Institute of Psychiatry, Department of Neurology, University of São Paulo Medical School, São Paulo, BrazilSearch for more papers by this authorMaria Gabriela dos Santos Ghilardi MD, Maria Gabriela dos Santos Ghilardi MD Division of Functional Neurosurgery of Institute of Psychiatry, Department of Neurology, University of São Paulo Medical School, São Paulo, BrazilSearch for more papers by this authorRubens Gisbert Cury MD, Rubens Gisbert Cury MD Movement Disorders Section, Department of Neurology, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, BrazilSearch for more papers by this authorEgberto Reis Barbosa MD, PhD, Egberto Reis Barbosa MD, PhD Movement Disorders Section, Department of Neurology, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, BrazilSearch for more papers by this authorManoel Jacobsen Teixeira MD, PhD, Manoel Jacobsen Teixeira MD, PhD Division of Functional Neurosurgery of Institute of Psychiatry, Department of Neurology, University of São Paulo Medical School, São Paulo, BrazilSearch for more papers by this authorErich Talamoni Fonoff MD, PhD, Corresponding Author Erich Talamoni Fonoff MD, PhD fonoffet@usp.br Division of Functional Neurosurgery of Institute of Psychiatry, Department of Neurology, University of São Paulo Medical School, São Paulo, BrazilCorresponding author: Dr. Erich Talamoni Fonoff, Dr. Ovídio Pires de Campos, 785 - São Paulo – SP – Brazil - 01060-970; fonoffet@usp.brSearch for more papers by this author Carolina Pinto de Souza MD, Carolina Pinto de Souza MD Division of Functional Neurosurgery of Institute of Psychiatry, Department of Neurology, University of São Paulo Medical School, São Paulo, BrazilSearch for more papers by this authorClement Hamani MD, PhD, Clement Hamani MD, PhD Division of Functional Neurosurgery of Institute of Psychiatry, Department of Neurology, University of São Paulo Medical School, São Paulo, BrazilSearch for more papers by this authorCarolina Oliveira Souza PhD, Carolina Oliveira Souza PhD Division of Functional Neurosurgery of Institute of Psychiatry, Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil Movement Disorders Section, Department of Neurology, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, BrazilSearch for more papers by this authorWilliam Omar Lopez Contreras MD, PhD, William Omar Lopez Contreras MD, PhD Division of Functional Neurosurgery of Institute of Psychiatry, Department of Neurology, University of São Paulo Medical School, São Paulo, BrazilSearch for more papers by this authorMaria Gabriela dos Santos Ghilardi MD, Maria Gabriela dos Santos Ghilardi MD Division of Functional Neurosurgery of Institute of Psychiatry, Department of Neurology, University of São Paulo Medical School, São Paulo, BrazilSearch for more papers by this authorRubens Gisbert Cury MD, Rubens Gisbert Cury MD Movement Disorders Section, Department of Neurology, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, BrazilSearch for more papers by this authorEgberto Reis Barbosa MD, PhD, Egberto Reis Barbosa MD, PhD Movement Disorders Section, Department of Neurology, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, BrazilSearch for more papers by this authorManoel Jacobsen Teixeira MD, PhD, Manoel Jacobsen Teixeira MD, PhD Division of Functional Neurosurgery of Institute of Psychiatry, Department of Neurology, University of São Paulo Medical School, São Paulo, BrazilSearch for more papers by this authorErich Talamoni Fonoff MD, PhD, Corresponding Author Erich Talamoni Fonoff MD, PhD fonoffet@usp.br Division of Functional Neurosurgery of Institute of Psychiatry, Department of Neurology, University of São Paulo Medical School, São Paulo, BrazilCorresponding author: Dr. Erich Talamoni Fonoff, Dr. Ovídio Pires de Campos, 785 - São Paulo – SP – Brazil - 01060-970; fonoffet@usp.brSearch for more papers by this author First published: 10 November 2016 https://doi.org/10.1002/mds.26850Citations: 63 Funding agency: : This study was funded by the Division of Functional Neurosurgery of Institute of Psychiatry of the Hospital das Clinicas of the University of São Paulo Medical School. Relevant conflicts of interests/financial disclosures: : Nothing to report. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat ABSTRACT Background Deep brain stimulation and levodopatherapy ameliorate motor manifestations in Parkinson's disease, but their effects on axial signs are not sustained in the long term. Objectives The objective of this study was to investigate the safety and efficacy of spinal cord stimulation on gait disturbance in advanced Parkinson's disease. Methods A total of 4 Parkinson's disease patients who experienced significant postural instability and gait disturbance years after chronic subthalamic stimulation were treated with spinal cord stimulation at 300 Hz. Timed-Up-GO and 20-meter-walk tests, UPDRS III, freezing of gait questionnaire, and quality-of-life scores were measured at 6 months and compared to baseline values. Blinded assessments to measure performance in the Timed-Up-GO and 20-meter-walk tests were carried out during sham stimulation at 300 Hz and 60 Hz. Results Patients treated with spinal cord stimulation had approximately 50% to 65% improvement in gait measurements and 35% to 45% in UPDRS III and quality-of-life scores. During blinded evaluations, significant improvements in the Timed-Up-GO and 20-meter-walk tests were only recorded at 300 Hz. Conclusion Spinal cord stimulation at 300 Hz was well tolerated and led to a significant improvement in gait. © 2016 International Parkinson and Movement Disorder Society. Citing Literature Supporting Information Additional Supporting Information may be found in the online version of this article at the publisher's web-site. Filename Description mds26850-sup-0001-suppinfo.docx781.8 KB Supplementary Information mds26850-sup-0002-suppvideo1.mp420.1 MB Supplementary Information Video 1. mds26850-sup-0003-suppvideo2.mp413.7 MB Supplementary Information Video 2. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article. Volume32, Issue2February 2017Pages 278-282 RelatedInformation