Effects of randomized STN-DBS on gait in patients with Parkinson’s disease. (P1.165)

OBJECTIVE: To identify the differential effects of unilateral subthalamic nucleus deep brain stimulation (STN-DBS) on gait kinematics in patients with Parkinson’s disease (PD) and associated gait dysfunction. BACKGROUND: STN-DBS improves motor symptoms in PD. However, unbalanced STN-DBS may worsen gait due to STN functional asymmetry. DESIGN/METHODS: Twenty-two PD patients with gait impairment after being treated with STN-DBS were tested in 4 randomly assigned conditions: bilateral (BL-ON), right (R-ON), left (L-ON) and bilateral off (BL-OFF) stimulation. Gait kinematics were evaluated in all conditions using wireless sensors. RESULTS: Without stimulation, mean MDS-UPDRS was 48.68±3.41 and PIGD (gait score) was 9.22±1.06. STN-DBS significantly improved these scores to 24.09±2.76 and 6.27±0.94(BL-ON). There were no differences between R-ON and L-ON in terms of motor scores (35.59±3.19 R-ON and 38.36±3.52 L-ON) or PIGD (7.4±0.94 R-ON and 7.63±0.97 L-ON). During BL-OFF, mean walking stride length was 0.95±0.06 m., velocity 0.85±0.07 m/s and turning time 4.89±0.6 sec. STN-DBS significantly improved stride length to 1.09±0.04 m., velocity to 0.96±0.05 m/s and turn time 4.13±0.5 sec. R-ON improved stride length more than L-ON (1.06±0.04 vs. 1.01±0.05; p=0.02). Similarly, velocity was better with R-ON (0.93±0.05 m/s) than with L-ON (0.90±0.05 m/s) (p=0.2). Stride length and velocity did not significantly change with worse side ON, but improved 0.09 m.(p=0.03) and 0.08 m/s(p=0.04) with best side ON. CONCLUSION: Right STN-DBS might have specific beneficial effects on gait parameters in PD patients. These asymmetric STN-DBS effects could have implications in clinical practice but require confirmation in larger studies. Disclosure: Dr. Lizarraga has nothing to disclose. Dr. Jagid has nothing to disclose. Dr. Gallo has received personal compensation for activities with Medtronic, St. Jude Medical, Teva, Boeringher Ingelheim, and Novartis as a consultant. Dr. Luca has nothing to disclose.