Chronic epidural spinal cord stimulation for gait impairments in Parkinson’s disease and atypical parkinsonism

Spinal cord stimulation is a well-established, minimally invasive surgical technique that has been effectively utilized for the treatment of chronic pain syndromes. In the past 15 years, there has been a significant increase in reports on the use of spinal stimulation for patients with advanced Parkinson's disease (PD), as well as in isolated cases of atypical parkinsonism. These reports frequently highlight a positive impact of spinal stimulation on gait impairments. A hallmark symptom of advanced PD, as well as several phenotypes of progressive supranuclear palsy, is the freezing of gait phenomenon. This condition, akin to postural instability, is likely linked to disruptions in multimodal integration across various levels of locomotor control. Given its poor responsiveness to dopaminergic therapy, freezing of gait remains one of the most debilitating symptoms in parkinsonism. This review consolidates current knowledge on the use of chronic epidural spinal cord stimulation in patients with PD and atypical parkinsonism, with a focus on its potential to alleviate locomotor disorders, particularly freezing of gait.