Abstract Details

Title Low Frequency Directional Deep Brain Stimulation of the Cuneiform Nucleus for Levodopa-resistant Freezing of Gait: Six-month Outcomes

Topic Movement Disorders

Presentation(s) P9 - Poster Session 9 (11:45 AM-12:45 PM)

Poster/Presentation
Number 5-002

Objective This is a prospective, open-label, single-arm study to assess safety and efficacy of cuneiform(CnF) deep brain stimulation(DBS) in Parkinson's disease(PD) patients with levodopa-refractory freezing of gait(FOG).

Background Freezing of gait in Parkinson's disease (PD) results in substantial disability particularly for those who do not respond to dopaminergic treatments. Our previous work employed, for the first time in humans, tractography and low frequency directional stimulation to precisely target the cuneiform nucleus (CnF). This study expands our previously published results by presenting the six-month outcomes for four patients with levodopa-resistant FOG who underwent CnF DBS.

Design/Methods This trial enrolled four PD patients with levodopa-resistant FOG (NCT04218526). Bilateral directional DBS leads were implanted into the CnF using pre-operative MRI and diffusion tractography. Electrode placement was performed under light sedation with intraoperative microelectrode recordings. Primary outcomes included the Timed Up and Go (TUG) test, the Pirouette test, and the Freezing of Gait Questionnaire (FOGQ). Quality of life was assessed using the Quality of Life Questionnaire (PDQL) and the PDQ-39 at six months.

Results

All four patients exhibited significant improvements in freezing of gait. TUG times improved by 59.4%, from a mean of 66 seconds (±37.8) to 26.4 seconds (±16.8). The Pirouette test showed a 48.95% improvement on the right side and 8.28% on the left, while FOGQ scores improved by 26.58%. However, quality of life assessments (PDQL and PDQ-39) did not reveal improvement in all patients at 28-weeks, likely due to disease progression, increased postural instability and the need for a walker for safe ambulation.

Adverse events included falls and stimulation-related visual side effects which were resolved with appropriate adjustments.

Conclusions

Low frequency directional DBS of the CnF shows promise for managing levodopa-resistant FOG in PD patients. Further research to identify the best neuromodulation parameters for CnF related gait network is necessary to improve outcomes.

Authors/Disclosures
Corneliu C. Luca, MD (University of Miami) PRESENTER	Dr. Luca has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Boston Scientific. Dr. Luca has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Signant Health. Dr. Luca has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Abbott.
Viviana Torres Ballesteros, Other	Ms. Torres Ballesteros has nothing to disclose.
Michael Baumgartner (University of Pennsylvania)	No disclosure on file
Jaskeerat Gujral, BA	Mr. Gujral has nothing to disclose.
Liming Qiu, MBBS	Dr. Qiu has nothing to disclose.
Guilherme Santos Piedade, MD, PhD	Dr. Santos Piedade has nothing to disclose.
Eva Widerstrom-Noga, PhD, DDS	The institution of Dr. Widerstrom-Noga has received research support from Department of Defense.
Ihtsham Haq, MD, FAAN (University of Miami Miller School of Medicine)	The institution of Dr. Haq has received research support from NINDS. The institution of Dr. Haq has received research support from the Parkinson's Foundation.
Brian Noga, PhD	The institution of Prof. Noga has received research support from Department of Defense.
Jonathan Jagid	Jonathan Jagid has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Miami Dade County State Attorneys office. The institution of Jonathan Jagid has received research support from Boston Scientific.
Iahn Cajigas, MD, PhD	Dr. Cajigas has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Medtronic.

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