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01-03-2021 | Spinal Cord Stimulation | Original Communication

Spinal cord stimulation therapy for gait dysfunction in progressive supranuclear palsy patients

Authors: Olivia Samotus, Andrew Parrent, Mandar Jog

Published in: Journal of Neurology | Issue 3/2021

Abstract

Background

There are no effective symptomatic treatments for progressive supranuclear palsy (PSP). Recent studies report benefits of spinal cord stimulation (SCS) for freezing of gait (FOG) and gait disorders in Parkinson’s disease and atypical Parkinsonism patients. This is the first study to report therapeutic effects of SCS in Richardson’s syndrome PSP (PSP-RS) patients.

Methods

Epidural SCS was implanted in three female PSP-RS participants (3.2 ± 1.3 years with disease). Six programs (300–400 µs/30–130 Hz) were randomly tested at suprathreshold intensity on separate days. The setting that best improved gait/FOG was used daily by each participant in the study. Protokinetics walkway captured spatiotemporal gait measures and FOG episodes (turning on the spot and while walking) and clinical scales including FOG questionnaire, UPDRS-III (OFF-/ON-l-dopa), and participant-perceived global impression of change (GISC) were collected at pre-SCS, and 3, 6, 12 months post-SCS.

Results

Participant #1 demonstrated the highest GISC score (6.5/10) with a consistent reduction of FOGs by 43.8%, UPDRS-III score (− 5 points), and improved step length and stride velocity (33.6%) while maintaining a l-dopa response of ~ 12% over the 12 months. Participant #2, walking FOG frequency and turning duration was reduced by 39.0% (OFF-l-dopa), and ON-l-dopa UPDRS-III score worsened (+ 5 points) at 12 months. Participant #3, FOG frequency reduced by 75% up to 6 months rating a GISC 3/10 score, however disease severity worsened at 12 months. Ambulatory gait parameters universally improved by 29.6% in all participants.

Conclusion

The results support the benefit of SCS for FOG and gait symptoms in PSP-RS and suggests early SCS intervention for dopaminergic-resistant gait should be considered.

Respondek G, Höglinger GU (2016) The phenotypic spectrum of progressive supranuclear palsy. Parkin Relat Disord 22:S34–S36. https://doi.org/10.1016/j.parkreldis.2015.09.041CrossRef

Clerici I, Ferrazzoli D, Maestri R et al (2017) Rehabilitation in progressive supranuclear palsy: Effectiveness of two multidisciplinary treatments. PLoS ONE 12(2):e0170927. https://doi.org/10.1371/journal.pone.0170927CrossRefPubMedPubMedCentral

Williams DR, de Silva R, Paviour DC et al (2005) Characteristics of two distinct clinical phenotypes in pathologically proven progressive supranuclear palsy: Richardson's syndrome and PSP-parkinsonism. Brain 128(Pt 6):1247–1258. https://doi.org/10.1093/brain/awh488CrossRefPubMed

Samotus O, Parrent A, Jog M (2018) Spinal cord stimulation therapy for gait dysfunction in advanced Parkinson’s disease patients. Mov Disord 33(5):783–792. https://doi.org/10.1002/mds.27299CrossRefPubMed

Cai Y, Reddy RD, Varshney V, Chakravarthy KV (2020) Spinal cord stimulation in Parkinson’s disease: a review of the preclinical and clinical data and future prospects. Bioelectron Med 6:5. https://doi.org/10.1186/s42234-020-00041-9CrossRefPubMedPubMedCentral

Zhang Y, Song T, Zhuang P et al (2020) Spinal cord stimulation improves freezing of gait in a patient with multiple system atrophy with predominant parkinsonism. Brain Stimul 13(3):653–654. https://doi.org/10.1016/j.brs.2020.02.006CrossRefPubMed

Samotus O, Parrent A, Jog M (2020) Long-term update of the effect of spinal cord stimulation in advanced Parkinson's disease patients. Brain Stimul. https://doi.org/10.1016/j.brs.2020.06.004CrossRefPubMed

dell'Aquila C, Zoccolella S, Cardinali V et al (2013) Predictors of survival in a series of clinically diagnosed progressive supranuclear palsy patients. Parkinsonism Relat Disord 19(11):980–985. https://doi.org/10.1016/j.parkreldis.2013.06.014CrossRefPubMed

Snijders AH, Haaxma CA, Hagen YJ, Munneke M, Bloem BR (2012) Freezer or non-freezer: clinical assessment of freezing of gait. Parkinsonism Relat Disord 18(2):149–154. https://doi.org/10.1016/j.parkreldis.2011.09.006CrossRefPubMed

10.

van Dijsseldonk K, Wang Y, van Wezel R, Bloem BR, Nonnekes J (2018) Provoking freezing of gait in clinical practice: turning in place is more effective than stepping in place. J Parkinsons Dis 8(2):363–365. https://doi.org/10.3233/JPD-181332CrossRefPubMed

11.

Hubsch C, D’Hardemare V, Ben Maacha M, Ziegler M, Patte-Karsenti N, Thiebaut JB, Gout O, Brandel JP (2019) Tonic spinal cord stimulation as therapeutic option in Parkinson disease with axial symptoms: effects on walking and quality of life. Parkinsonism Relat Disord 63:235–237. https://doi.org/10.1016/j.parkreldis.2019.02.044CrossRefPubMed

12.

Fuentes R, Petersson P, Nicolelis MAL (2010) Restoration of locomotive function in Parkinson’s disease by spinal cord stimulation: mechanistic approach. Eur J Neurosci 32(7):1100–1108. https://doi.org/10.1111/j.1460-9568.2010.07417.xCrossRefPubMedPubMedCentral

13.

Perez Parra S, McKay JL, Factor SA (2020) diphasic worsening of freezing of gait in Parkinson's Disease. Mov Disord Clin Pract 7(3):325–328. https://doi.org/10.1002/mdc3.12918CrossRefPubMedPubMedCentral

14.

Espay AJ, Fasano A, van Nuenen BF, Payne MM, Snijders AH, Bloem BR (2012) "On" state freezing of gait in Parkinson disease: a paradoxical levodopa-induced complication. Neurology 78(7):454–457. https://doi.org/10.1212/WNL.0b013e3182477ec0CrossRefPubMedPubMedCentral

15.

Bloem BR, Hausdorff JM, Visser JE, Giladi N (2004) Falls and freezing of gait in Parkinson's disease: a review of two interconnected, episodic phenomena. Mov Disord 19(8):871–884. https://doi.org/10.1002/mds.20115CrossRefPubMed

16.

Fleury V, Pollak P, Gere J et al (2016) Subthalamic stimulation may inhibit the beneficial effects of levodopa on akinesia and gait. Mov Disord 31(9):1389–1397. https://doi.org/10.1002/mds.26545CrossRefPubMed

17.

Mei S, Li J, Middlebrooks EH et al (2019) New Onset On-Medication Freezing of Gait After STN-DBS in Parkinson's Disease. Front Neurol 10:659. https://doi.org/10.3389/fneur.2019.00659CrossRefPubMedPubMedCentral

18.

de Souza CP, Hamani C, Oliveira Souza C, Lopez Contreras WO, Dos Santos Ghilardi MG et al (2017) Spinal cord stimulation improves gait in patients with Parkinson’s disease previously treated with deep brain stimulation. Mov Disord Off J Mov Disord Soc 32:278–282. https://doi.org/10.1002/mds.26850CrossRef

19.

Mazzone P, Viselli F, Ferraina S et al (2019) High cervical spinal cord stimulation: a one year follow-up study on motor and non-motor functions in Parkinson’s Disease. Brain Sci 9(4):78. https://doi.org/10.3390/brainsci9040078CrossRefPubMedCentral

20.

Rohani M, Kalsi-Ryan S, Lozano AM, Fasano A (2017) Spinal cord stimulation in primary progressive freezing of gait. Mov Disord 32(9):1336–1337. https://doi.org/10.1002/mds.27103CrossRefPubMed

21.

de Souza CP, Dos Santos MGG, Hamani C, Fonoff ET (2018) Spinal cord stimulation for gait dysfunction in Parkinson's disease: Essential questions to discuss. Mov Disord 33(11):1828–1829. https://doi.org/10.1002/mds.27508CrossRefPubMed

22.

Fonoff ET, de Lima-Pardini AC, Coelho DB et al (2019) Spinal cord stimulation for freezing of gait: from bench to bedside. Front Neurol 10:905. https://doi.org/10.3389/fneur.2019.00905CrossRefPubMedPubMedCentral

23.

Kobayashi R, Kenji S, Taketomi A, Murakami H, Ono K, Otake H (2018) New mode of burst spinal cord stimulation improved mental status as well as motor function in a patient with Parkinson’s disease. Parkinsonism Relat Disord 57:82–83. https://doi.org/10.1016/j.parkreldis.2018.07.002CrossRefPubMed

24.

Yearwood TL, Hershey B, Bradley K, Lee D (2010) Pulse width programming in spinal cord stimulation: a clinical study. Pain Phys 13:321–335

25.

Ginis P, Nackaerts E, Nieuwboer A, Heremans E (2018) Cueing for people with Parkinson's disease with freezing of gait: a narrative review of the state-of-the-art and novel perspectives. Ann Phys Rehabil Med 61(6):407–413. https://doi.org/10.1016/j.rehab.2017.08.002CrossRefPubMed

26.

de Lima-Pardini AC, Coelho DB, Souza CP et al (2018) Effects of spinal cord stimulation on postural control in Parkinson's disease patients with freezing of gait. Elife 7:e37727. https://doi.org/10.7554/eLife.37727CrossRefPubMedPubMedCentral

27.

Duarte RV, McNicol E, Colloca L, Taylor RS, North RB, Eldabe S (2020) Randomized placebo-/sham-controlled trials of spinal cord stimulation: a systematic review and methodological appraisal. Neuromodulation 23(1):10–18. https://doi.org/10.1111/ner.13018CrossRefPubMed

Title: Spinal cord stimulation therapy for gait dysfunction in progressive supranuclear palsy patients
Authors: Olivia Samotus
Andrew Parrent
Mandar Jog
Publication date: 01-03-2021
Publisher: Springer Berlin Heidelberg
Keywords: Spinal Cord Stimulation
Levodopa
Progressive Supranuclear Palsy
Published in: Journal of Neurology / Issue 3/2021
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI: https://doi.org/10.1007/s00415-020-10233-7

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Spinal cord stimulation therapy for gait dysfunction in progressive supranuclear palsy patients

Abstract

Background

Methods

Results

Conclusion

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Abstract

Background

Methods

Results

Conclusion

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