Prediction of the effect of deep brain stimulation on gait freezing of Parkinson's disease |
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| Affiliation: | 1. Department of Cardiology, Angiology and Intensive Care, Klinikum Chemnitz gGmbH, Medizincampus Chemnitz der Technischen Universität Dresden, Dresden, Germany;2. Department of Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany;3. Medizinische Klinik und Poliklinik I, Klinikum der Universität, LMU Munich, 81377, Munich, Germany;4. German Center for Cardiovascular Research, Partner Site Munich Heart Alliance, 80802, Munich, Germany;5. Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany;6. Movement Disorders Outpatient Clinic, Department of Molecular Neurology, University Hospital Erlangen, Schwabachanlage 6, 91054, Erlangen, Germany;7. Center for Rare Movement Disorders, Department of Molecular Neurology, University Hospital Erlangen, Schwabachanlage 6, 91054, Erlangen, Germany;8. Department of Neurology, St. Josef Hospital, Ruhr-University, Gudrunstraße 56, 44791, Bochum, Germany;9. Neurologische Klinik und Poliklinik, Ludwig-Maximilians-Universität München, München, Germany;10. Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany;11. Translational Neurodegeneration Section “Albrecht-Kossel”, Department of Neurology, University Medical Center, University of Rostock, Rostock, Germany;12. DZNE, German Center for Neurodegenerative Diseases, Research Site Rostock/Greifswald, Rostock, Germany;13. Center for Transdisciplinary Neurosciences Rostock (CTNR), University Medical Center Rostock, University of Rostock, Rostock, Germany |
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| Abstract: | ObjectiveThe response of freezing of gait (FOG) to deep brain stimulation of the subthalamic nucleus (STN-DBS) is controversial and depends on many poorly controlled factors. On the other hand, a clinical predictor for the individual patient is needed to counsel the patient regarding this symptom.MethodsA cohort of 124 patients undergoing STN-DBS was evaluated based on the video-documented Levodopa test at baseline in the OFF- and ON-drug condition and postoperatively in the best condition (ON-drug/ON-stim) and the worst condition (OFF-drug/ON-stim). We compared the freezing item of the Unified Parkinson's disease rating scale (#14), the UPDRS III total score, and FOG severity rated during four provoking situations with regard to its predictive value.ResultsWe found ‘FOG during the turning task’ to be the best predictor with an ROC-value of 0.857 compared to 0.603 for the UPDRS Item 14 and 0.583 for the total UPDRS III. An improvement of 1 or 2 grades of the turning item during the preoperative levodopa test predicts an improvement during the worst condition postoperatively of 1 grade or more with an 80% probability.ConclusionThis FOG prediction test is simple and clinically useful. The test needs to be studied in a prospective study. |
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| Keywords: | Parkinson's disease Deep brain stimulation Freezing of gait Prediction |
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