Cebi Idil, Scholten Marlieke, Gharabaghi Alireza, Weiss Daniel
Department of Neurodegenerative Diseases, Centre for Neurology, Hertie Institute for Clinical Brain Research (HIH), University of Tübingen, Tübingen, Germany.
German Centre of Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany.
Front Neurol. 2020 Apr 22;11:212. doi: 10.3389/fneur.2020.00212. eCollection 2020.
Gait and freezing of gait (FoG) are highly relevant to the outcomes of subthalamic nucleus deep brain stimulation (STN-DBS) in Parkinson's disease (PD). Previous studies pointed to variable response to combined dopaminergic and STN-DBS treatment. Here, we performed a prospective exploratory study on associations of preoperative clinical and kinematic gait measures with quantitative gait and FoG outcomes after STN-DBS implantation. We characterized 18 consecutive PD patients (13 freezers) before and after STN-DBS implantation. The patients received preoperative levodopa challenges (MedOff vs. MedOn) and a postoperative reassessment at 6 months from surgery in MedOn/StimOn condition. We correlated the FoG outcome, calculated as improvement of Freezing of Gait Assessment Course (FoG-AC) from baseline MedOff to 6-month follow-up MedOn/StimOn, with the levodopa response of preoperative clinical and kinematic gait measures. We considered measures with significant correlations for a multiple regression model. We found that the postoperative gait and FoG outcomes were associated with the preoperative levodopa response of clinical and kinematic gait measures. In particular, preoperative levodopa sensitivity of FoG showed high correlation with a favorable quantitative FoG outcome. Among kinematic measures, preoperative levodopa response of stride length and range of motion showed high correlation with favorable FoG outcome. In addition, the preoperative levodopa sensitivity of FoG predicted postoperative FoG outcome with high accuracy ( = 0.952; 95% CI: 0.95-1.29; < 0.001). Preoperative clinical and kinematic measures correlated with favorable postoperative gait and FoG outcomes. The findings should be reproduced in larger and independent cohorts to verify their predictive value.
步态和步态冻结（FoG）与帕金森病（PD）丘脑底核深部脑刺激（STN-DBS）的疗效高度相关。先前的研究指出，多巴胺能治疗与STN-DBS联合治疗的反应存在差异。在此，我们进行了一项前瞻性探索性研究，以探讨术前临床和运动学步态指标与STN-DBS植入术后定量步态和FoG结果之间的关联。我们对18例连续的PD患者（13例步态冻结患者）在STN-DBS植入前后进行了特征描述。患者接受了术前左旋多巴激发试验（药物关闭状态与药物开启状态），并在术后6个月在药物开启/刺激开启状态下进行了重新评估。我们将步态冻结结果（计算为从基线药物关闭状态到6个月随访药物开启/刺激开启状态的步态冻结评估课程（FoG-AC）的改善情况）与术前临床和运动学步态指标的左旋多巴反应进行了关联分析。我们将具有显著相关性的指标纳入多元回归模型。我们发现，术后步态和FoG结果与术前临床和运动学步态指标的左旋多巴反应相关。特别是，术前步态冻结的左旋多巴敏感性与良好的定量FoG结果高度相关。在运动学指标中，术前步长和运动范围的左旋多巴反应与良好的FoG结果高度相关。此外，术前步态冻结的左旋多巴敏感性对术后FoG结果具有较高的预测准确性（ = 0.952；95%可信区间：0.95 - 1.29； < 0.001）。术前临床和运动学指标与良好的术后步态和FoG结果相关。这些发现应在更大的独立队列中进行重复验证，以证实其预测价值。
