Abstract Details

Title Acute and Chronic Effects of Deep Brain Stimulation on Gait Kinematics in Patients with Parkinson’s Disease

Topic Movement Disorders

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

Poster/Presentation
Number 5-008

Objective To investigate the acute and chronic effects of deep brain stimulation (DBS) of the subthalamic nucleus (STN) or globus pallidus internus (GPi) on gait in patients with Parkinson’s disease (PD)

Background The effect of DBS on gait is variable. Few studies have followed patients longitudinally with quantitative gait kinematics. We hypothesize that STN and GPi DBS exert acute and chronic effects on gait

Design/Methods Gait kinematics were collected on PD patients implanted with STN or GPi DBS using a pressure sensitive walkway (Protokinetics Zeno). Patients were followed prospectively, and data were collected at baseline before initial DBS activation (n=104), acutely after activation (n=102), and chronically at 1 month (n=75) and 12 months (n=82). Multiple gait kinematic variables were analyzed longitudinally to account for gait domains including gait pace, variability, rhythm, asymmetry, and postural control

Results We report the longitudinal changes in gait velocity which is impaired (<100cm/s) in PD. At baseline, gait velocity mean was abnormally slow (80.6 cm/s). Velocity significantly increased acutely after DBS activation (97.9 cm/s), and the velocity improvement was maintained at 1 month (92 cm/s) and 12 months follow up (median 91.6 cm/s). The effect of bilateral STN stimulation on velocity was significantly greater than that of unilateral STN or GPi stimulation at 1 and 12 months. Individual-level analysis shows that of the patients with longitudinal follow up, 34% had clinically significant velocity improvement (>10cm/s), 51% had no change and 15% had worsening. The improvement was usually immediate (71%), while worsening was typically delayed (75%)

Conclusions DBS improves gait velocity immediately and the effect can be maintained chronically after 12 months. This effect may depend on the stimulation target and laterality. The rapid response suggests that improved gait velocity may be related to reduction of pathologic oscillatory neural activity while the delayed effects may involve reorganization of stimulated neuronal networks

Authors/Disclosures
Jamal Al Ali, MD PRESENTER	Dr. Al Ali has nothing to disclose.
Johnathan L. McKay, PhD (Emory University)	The institution of Dr. McKay has received research support from NIH. The institution of Dr. McKay has received research support from the McCamish Foundation.
Joe Nocera, PhD	Dr. Nocera has nothing to disclose.
Faical Isbaine (Emory University)	Faical Isbaine has received personal compensation for serving as an employee of Dixi Medical.
Julie T. Tran, BS	Ms. Tran has nothing to disclose.
Paola Testini, MD (University of Utah)	Dr. Testini has nothing to disclose.
Shirley Triche	No disclosure on file
Christine D. Esper, MD, FANA, FAAN (Emory Brain Health Center)	Dr. Esper has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Parkinson's Study Group. Dr. Esper has received research support from Centers for Disease Control and Prevention. Dr. Esper has received research support from Michael J. Fox Foundation. Dr. Esper has received research support from McCamish Parkinson's Disease Innovation Program. Dr. Esper has received publishing royalties from a publication relating to health care.
Pratibha Aia, MD (Emory)	Dr. Aia has nothing to disclose.
Laura M. Scorr, MD	Dr. Scorr has received research support from Dystonia Medical Research Foundation.
Lenora A. Higginbotham, MD (Emory University)	The institution of Dr. Higginbotham has received research support from NIH/NINDS . The institution of Dr. Higginbotham has received research support from Bright Focus Foundation. The institution of Dr. Higginbotham has received research support from ��ɫ��. Dr. Higginbotham has received intellectual property interests from a discovery or technology relating to health care.
Richa Tripathi, MD (Emory University)	Dr. Tripathi has nothing to disclose.
Svjetlana Miocinovic, MD, PhD (Emory University)	Dr. Miocinovic has nothing to disclose.
Cathrin M. Buetefisch, MD, PhD	The institution of Dr. Buetefisch has received research support from NIH.

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