Research Center for Neuromodulation and Pain, Shiraz, Iran.
Unite de Recherche Clinique du Centre Hospitalier Henri Laborit, Poitiers, France.
Br J Neurosurg. 2023 Feb;37(1):3-11. doi: 10.1080/02688697.2022.2077308. Epub 2022 May 23.
Freezing of gait (FOG) is a disabling gait disorder in patients with Parkinson's disease (PD), characterized by recurrent episodes of halting steps. Dopaminergic drugs are common treatments for PD and FOG; however, these drugs may worsen FOG. Deep brain stimulation (DBS) is another option used to treat selected patients. The device needs to be programmed at a specific frequency, amplitude, and pulse width to achieve optimum effects for each patient. This systematic review aimed to evaluate the efficacy of DBS for FOG and its correlation with programmed parameters and the location of the electrodes in the brain.
Data for this systematic review were gathered from five online databases: Medline ( PubMed), Scopus, Embase, Web of Science, and Cochrane Library (including both Cochrane Reviews and Cochrane Trials) with a broad search strategy. We included those articles that reported clinical trials and a specific measurement for FOG.
This review included 13 studies of DBS that targeted the subthalamic nucleus (STN), substantia nigra (SNr), or pedunculopontine nucleus (PPN). Our analysis showed that low-frequency stimulation (LFS) was superior to high-frequency stimulation (HFS) for improving FOG. In the long term, the efficacy of both LFS and HFS decreased. The effect of amplitude was variable, and this parameter needed to be adjusted for each patient. Bilateral stimulation was better than unilateral stimulation.
DBS is a promising choice for the treatment of severe FOG in patients with PD. Bilateral, low-frequency stimulation combined with medical therapy is associated with better responses, especially in the first 2 years of treatment. However, individualizing the DBS parameters should be considered to optimize treatment response.
冻结步态（FOG）是帕金森病（PD）患者的一种致残性步态障碍，其特征是反复出现停顿的步伐。多巴胺能药物是治疗 PD 和 FOG 的常用方法；然而，这些药物可能会使 FOG 恶化。深部脑刺激（DBS）是另一种用于治疗选定患者的选择。该设备需要以特定的频率、幅度和脉冲宽度编程，以实现每个患者的最佳效果。本系统评价旨在评估 DBS 治疗 FOG 的疗效及其与编程参数和大脑中电极位置的相关性。
本系统评价的数据来自五个在线数据库：Medline（PubMed）、Scopus、Embase、Web of Science 和 Cochrane Library（包括 Cochrane 综述和 Cochrane 试验），采用广泛的搜索策略。我们纳入了那些报告了针对丘脑底核（STN）、黑质（SNr）或脑桥被盖核（PPN）的临床试验和特定 FOG 测量的文章。
本综述纳入了 13 项针对 STN、SNr 或 PPN 的 DBS 研究。我们的分析表明，低频刺激（LFS）优于高频刺激（HFS）改善 FOG。长期来看，LFS 和 HFS 的疗效均下降。幅度的效果是可变的，需要针对每个患者进行调整。双侧刺激优于单侧刺激。
DBS 是治疗 PD 严重 FOG 的一种有前途的选择。双侧、低频刺激结合药物治疗与更好的反应相关，尤其是在治疗的前 2 年。然而，应考虑个体化 DBS 参数以优化治疗反应。
