Differential spatiotemporal gait effects with frequency and dopaminergic modulation in STN-DBS

Published on September 29, 2023

Imagine Parkinson’s disease as a symphony, with the brain as the conductor. In this magnificent performance, the dancers, our lower limbs, showcase their moves in a beautifully choreographed gait. However, sometimes the dancers stumble, and that’s where deep brain stimulation (STN-DBS) and medication step in as backup dancers to help them regain their grace. A study investigating the effects of different frequencies of STN-DBS (low-frequency and high-frequency) and L-dopa medication on the dancers’ performance found that they each played a unique role. The high-frequency STN-DBS improved trunk and lumbar movements, while low-frequency STN-DBS showed equivalent effects in other gait features. Additionally, when L-dopa joined the dance floor, it synergistically enhanced certain gait parameters like single limb support and foot swing. These findings highlight the intricate interplay between different treatment modalities and offer valuable insights into optimizing gait in advanced Parkinson’s disease. So put on your dancing shoes and delve into the fascinating world of neurostimulation research to uncover more mesmerizing discoveries!

ObjectiveThe spatiotemporal gait changes in advanced Parkinson’s disease (PD) remain a treatment challenge and have variable responses to L-dopa and subthalamic deep brain stimulation (STN-DBS). The purpose of this study was to determine whether low-frequency STN-DBS (LFS; 60 Hz) elicits a differential response to high-frequency STN-DBS (HFS; 180 Hz) in spatiotemporal gait kinematics.MethodsAdvanced PD subjects with chronic STN-DBS were evaluated in both the OFF and ON medication states with LFS and HFS stimulation. Randomization of electrode contact pairs and frequency conditions was conducted. Instrumented Stand and Walk assessments were carried out for every stimulation/medication condition. LM-ANOVA was employed for analysis.ResultsTwenty-two PD subjects participated in the study, with a mean age (SD) of 63.9 years. Significant interactions between frequency (both LFS and HFS) and electrode contact pairs (particularly ventrally located contacts) were observed for both spatial (foot elevation, toe-off angle, stride length) and temporal (foot speed, stance, single limb support (SLS) and foot swing) gait parameters. A synergistic effect was also demonstrated with L-dopa and both HFS and LFS for right SLS, left stance, left foot swing, right toe-off angle, and left arm range of motion. HFS produced significant improvement in trunk and lumbar range of motion compared to LFS.ConclusionThe study provides evidence of synergism of L-dopa and STN-DBS on lower limb spatial and temporal measures in advanced PD. HFS and LFS STN-DBS produced equivalent effects among all other tested lower limb gait features. HFS produced significant trunk and lumbar kinematic improvements.

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