Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil.
Functional Neurosurgery Division, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil.
J Clin Neurosci. 2020 Nov;81:306-309. doi: 10.1016/j.jocn.2020.10.001. Epub 2020 Oct 20.
Dopaminergic drugs partially alleviate gait problems in Parkinson's disease, but the effects are not sustained in the long-term. Particularly, the freezing of gait directly impacts patients' quality of life. Experimental epidural spinal cord stimulation (SCS) studies have suggested positive effects on locomotion among PD patients, but the effects of non-invasive stimulation have never been explored. Here, we investigated in a prospective, open-label, pilot study the efficacy and safety of non-invasive magnetic stimulation of the spinal cord in five patients with PD who experienced gait problems, including freezing of gait. A trial of transcutaneous magnetic SCS was performed at the level of the fifth thoracic vertebra. The primary outcome was the change in freezing of gait 7 days after stimulation. Secondary outcome measures included changes in gait speed and UPDRS part III. After non-invasive spinal cord stimulation, patients experienced a 22% improvement in freezing of gait (p = 0.040) and 17.4% improvement in the UPDRS part III (p = 0.042). Timed up and go times improved by 48.2%, although this did not reach statistical significance (p = 0.06). Patients' global impression of change was 'much improved' for four patients. Improvement in gait after stimulation was reversible, since it returned to baseline scores 4 weeks after stimulation. No severe side effects were recorded. This pilot study suggests that transcutaneous magnetic spinal cord stimulation is feasible and can potentially improve gait problems in PD, without severe adverse effects. Large scale phase II trials are needed to test this hypothesis.
多巴胺能药物部分缓解帕金森病的步态问题，但长期效果不持久。特别是步态冻结直接影响患者的生活质量。实验性硬膜外脊髓刺激（SCS）研究表明对 PD 患者的运动有积极影响，但非侵入性刺激的效果从未被探索过。在这里，我们在一项前瞻性、开放标签、初步研究中调查了对 5 名经历步态问题（包括步态冻结）的 PD 患者进行非侵入性脊髓磁刺激的疗效和安全性。在第五胸椎水平进行经皮磁 SCS 试验。主要结果是刺激后 7 天步态冻结的变化。次要结果测量包括步态速度和 UPDRS 第三部分的变化。在非侵入性脊髓刺激后，患者的步态冻结改善了 22%（p=0.040），UPDRS 第三部分改善了 17.4%（p=0.042）。计时起立行走时间提高了 48.2%，尽管这没有达到统计学意义（p=0.06）。四名患者的整体变化印象为“明显改善”。刺激后步态的改善是可逆的，因为刺激后 4 周恢复到基线评分。没有记录到严重的副作用。这项初步研究表明，经皮磁脊髓刺激是可行的，并且可能潜在地改善 PD 的步态问题，而没有严重的不良影响。需要进行大规模的 II 期试验来验证这一假设。
