gms | German Medical Science

62nd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Polish Society of Neurosurgeons (PNCH)

German Society of Neurosurgery (DGNC)

7 - 11 May 2011, Hamburg

Pallidal deep brain stimulation may induce a hypokinetic gait disorder and freezing of gait in patients with focal and segmental dystonia

Meeting Abstract

  • C. Schrader - Neurologische Klinik, Medizinische Hochschule Hannover, Deutschland
  • H.H. Capelle - Neurochirurgische Klinik, Medizinische Hochschule Hannover, Deutschland
  • G. Lütjens - Neurochirurgische Klinik, Medizinische Hochschule Hannover, Deutschland
  • C. Blahak - Neurologische Klinik, Universitätsklinikum Mannheim, Deutschland
  • H. Baezner - Neurologische Klinik, Universitätsklinikum Mannheim, Deutschland
  • D. Dressler - Neurologische Klinik, Medizinische Hochschule Hannover, Deutschland
  • J.K. Krauss - Neurochirurgische Klinik, Medizinische Hochschule Hannover, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocMO.12.12

doi: 10.3205/11dgnc097, urn:nbn:de:0183-11dgnc0974

Published: April 28, 2011

© 2011 Schrader et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: Deep brain stimulation (DBS) of the globus pallidus internus (GPi) has been shown to be an effective, well-tolerated, and safe treatment for patients with medically refractory segmental and generalized dystonia. Just recently, stimulation-induced hypokinesia, gait disorder, or parkinsonism have been reported as side effects of chronic DBS of the GPi; The aim of this work was to determine the frequency and the nature of this stimulation- induced gait disorder.

Methods: We retrospectively screened our database of dystonia patients who underwent DBS of the posteroventral GPi in the period between 2006 and 2009. Those who spontaneously reported a newly emerged gait disorder after DBS were included in this study.

Results: Among a collective of 52 dystonia patients, we identified 6 patients (2 male, 4 female, mean age 61.3 years (48-69 yrs), two craniocervical dystonia, one DYT-1 positive segmental dystonia of the arms, two tardive dystonias, one dystonic camptocormia) who met the inclusion criteria. In all of these patients, DBS had significantly suppressed dystonia. The two tardive dystonia patients exhibited a somewhat unsteady gait prior to DBS. After DBS, all of them described a gait disorder closely resembling freezing of gait (FOG): difficulties with gait initiation, tripping, turning difficulties, having their “feet glued to the ground”. While dystonia improved at higher amplitudes, FOG occurred, mostly immediately, sometimes worsening, over a period of a few hours and vanishing within minutes after turning off the DBS. In one patient, dystonia was well-controlled by reducing the frequency from 130 to 60 Hz without the recurrence of FOG; in the other 5 patients, after extensive testing of settings (monopolar, bipolar, pulse width 60-210 µs, frequency 60-180 Hz) no optimal configuration was found, so a compromise between improvement of dystonia and stimulation-induced adverse effects had to be made.

Conclusions: Almost 12% of our series showed a stimulation-induced FOG following GPi DBS, and therefore this should be an issue in preoperative counselling. In most cases, a compromise between treatment of dystonia and FOG is necessary. Due to our small cohort we failed to identify any predictive factors.