Spinal cord stimulation therapy for gait dysfunction in progressive supranuclear palsy patients
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Spinal cord stimulation therapy for gait dysfunction in progressive supranuclear palsy patients Olivia Samotus1,2 · Andrew Parrent1,2 · Mandar Jog1,2 Received: 25 July 2020 / Revised: 15 September 2020 / Accepted: 17 September 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Background There are no effective symptomatic treatments for progressive supranuclear palsy (PSP). Recent studies report benefits of spinal cord stimulation (SCS) for freezing of gait (FOG) and gait disorders in Parkinson’s disease and atypical Parkinsonism patients. This is the first study to report therapeutic effects of SCS in Richardson’s syndrome PSP (PSP-RS) patients. Methods Epidural SCS was implanted in three female PSP-RS participants (3.2 ± 1.3 years with disease). Six programs (300–400 µs/30–130 Hz) were randomly tested at suprathreshold intensity on separate days. The setting that best improved gait/FOG was used daily by each participant in the study. Protokinetics walkway captured spatiotemporal gait measures and FOG episodes (turning on the spot and while walking) and clinical scales including FOG questionnaire, UPDRS-III (OFF-/ ON-l-dopa), and participant-perceived global impression of change (GISC) were collected at pre-SCS, and 3, 6, 12 months post-SCS. Results Participant #1 demonstrated the highest GISC score (6.5/10) with a consistent reduction of FOGs by 43.8%, UPDRSIII score (− 5 points), and improved step length and stride velocity (33.6%) while maintaining a l-dopa response of ~ 12% over the 12 months. Participant #2, walking FOG frequency and turning duration was reduced by 39.0% (OFF-l-dopa), and ON-l-dopa UPDRS-III score worsened (+ 5 points) at 12 months. Participant #3, FOG frequency reduced by 75% up to 6 months rating a GISC 3/10 score, however disease severity worsened at 12 months. Ambulatory gait parameters universally improved by 29.6% in all participants. Conclusion The results support the benefit of SCS for FOG and gait symptoms in PSP-RS and suggests early SCS intervention for dopaminergic-resistant gait should be considered. Keywords Progressive supranuclear palsy · Atypical parkinsonian · Spinal cord stimulation · Freezing of gait · Gait dysfunction · Spatiotemporal · Gait analysis · Neuromodulation
Introduction * Mandar Jog [email protected] Olivia Samotus [email protected] Andrew Parrent [email protected] 1
Department of Clinical Neurological Sciences, London Health Sciences Centre, Lawson Health Research Institute, 339 Windermere Road, A10‑026, London, ON N6A 5A5, Canada
Schulich School of Medicine and Dentistry, University of Western, 1151 Richmond Street, London, ON N6A 3K7, Canada
2
Richardson syndrome progressive supranuclear palsy (PSPRS) is the most common form of atypical parkinsonism characterized by a rapid progression of clinical features including early postural instability, recurrent falls, freezing of gait (FOG), speech and swallowing difficulties, axial bradykinesia and rigidity, and vertical supranuclear gaze p
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