title: Spinal cord stimulation improves gait in patients with Parkinson's disease previously treated with deep brain stimulation.
abstract: Deep brain stimulation and levodopatherapy ameliorate motor manifestations in Parkinson's disease, but their effects on axial signs are not sustained in the long term.
  
  
  
  The objective of this study was to investigate the safety and efficacy of spinal cord stimulation on gait disturbance in advanced Parkinson's disease.
  
  
  
  A total of 4 Parkinson's disease patients who experienced significant postural instability and gait disturbance years after chronic subthalamic stimulation were treated with spinal cord stimulation at 300 Hz. Timed-Up-GO and 20-meter-walk tests, UPDRS III, freezing of gait questionnaire, and quality-of-life scores were measured at 6 months and compared to baseline values. Blinded assessments to measure performance in the Timed-Up-GO and 20-meter-walk tests were carried out during sham stimulation at 300 Hz and 60 Hz.
  
  
  
  Patients treated with spinal cord stimulation had approximately 50% to 65% improvement in gait measurements and 35% to 45% in UPDRS III and quality-of-life scores. During blinded evaluations, significant improvements in the Timed-Up-GO and 20-meter-walk tests were only recorded at 300 Hz.
  
  
  
  Spinal cord stimulation at 300 Hz was well tolerated and led to a significant improvement in gait. © 2016 International Parkinson and Movement Disorder Society.
authors.affiliation: Division of Functional Neurosurgery of Institute of Psychiatry, Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Carolina
authors.initials: C
authors.lastname: Pinto de Souza
authors.affiliation: Division of Functional Neurosurgery of Institute of Psychiatry, Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Clement
authors.initials: C
authors.lastname: Hamani
authors.affiliation: Division of Functional Neurosurgery of Institute of Psychiatry, Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil.|Movement Disorders Section, Department of Neurology, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Carolina
authors.initials: C
authors.lastname: Oliveira Souza
authors.affiliation: Division of Functional Neurosurgery of Institute of Psychiatry, Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: William Omar
authors.initials: WO
authors.lastname: Lopez Contreras
authors.affiliation: Division of Functional Neurosurgery of Institute of Psychiatry, Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Maria Gabriela
authors.initials: MG
authors.lastname: Dos Santos Ghilardi
authors.affiliation: Movement Disorders Section, Department of Neurology, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Rubens Gisbert
authors.initials: RG
authors.lastname: Cury
authors.affiliation: Movement Disorders Section, Department of Neurology, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Egberto
authors.initials: E
authors.lastname: Reis Barbosa
authors.affiliation: Division of Functional Neurosurgery of Institute of Psychiatry, Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Manoel
authors.initials: M
authors.lastname: Jacobsen Teixeira
authors.affiliation: Division of Functional Neurosurgery of Institute of Psychiatry, Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Erich
authors.initials: E
authors.lastname: Talamoni Fonoff
mesh_terms: D000368:Aged; D046690:Deep Brain Stimulation; D005260:Female; D020233:Gait Disorders, Neurologic / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010300:Parkinson Disease / Q000150:complications / Q000628:therapy*; D016037:Single-Blind Method; D062187:Spinal Cord Stimulation / Q000379:methods*
keywords: freezing of gait; locomotion; parkinson; postural instability and gait disturbances; spinal cord