gms | German Medical Science

73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

29.05. - 01.06.2022, Köln

Gait alterations in Parkinson’s disease after deep brain stimulation – A ventrocaudal arrangement of “sweet” and “sour spots” within the subthalamic nucleus?

Gangstörungen bei M. Parkinson nach tiefer Hirnstimulation: Eine ventrokaudale Ausrichtung von „sweet“ und „sour spots“ im Nucleus subthalamicus?

Meeting Abstract

  • presenting/speaker Robert Nickl - Universitätsklinikum Würzburg, Neurochirurgische Klinik und Poliklinik, Würzburg, Deutschland
  • Anne Großmann - Universitätsklinikum Würzburg, Neurochirurgische Klinik und Poliklinik, Würzburg, Deutschland
  • Hazem ElDeBakey - Universitätsklinikum Würzburg, Neurologische Klinik und Poliklinik, Würzburg, Deutschland
  • Jonas Roothans - Universitätsklinikum Würzburg, Neurologische Klinik und Poliklinik, Würzburg, Deutschland
  • Ioannis Isaias - Universitätsklinikum Würzburg, Neurologische Klinik und Poliklinik, Würzburg, Deutschland
  • Florian Lange - Universitätsklinikum Würzburg, Neurologische Klinik und Poliklinik, Würzburg, Deutschland
  • Patrick Fricke - Universitätsklinikum Würzburg, Neurochirurgische Klinik und Poliklinik, Würzburg, Deutschland
  • Cordula Matthies - Universitätsklinikum Würzburg, Neurochirurgische Klinik und Poliklinik, Würzburg, Deutschland
  • Jens Volkmann - Universitätsklinikum Würzburg, Neurologische Klinik und Poliklinik, Würzburg, Deutschland
  • Martin Reich - Universitätsklinikum Würzburg, Neurologische Klinik und Poliklinik, Würzburg, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie. Köln, 29.05.-01.06.2022. Düsseldorf: German Medical Science GMS Publishing House; 2022. DocP097

doi: 10.3205/22dgnc407, urn:nbn:de:0183-22dgnc4070

Published: May 25, 2022

© 2022 Nickl et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objective: Impairment of mobility by gait disturbances is a common clinical problem in Parkinson’s disease after bilateral deep brain stimulation of the subthalamic nucleus. We aimed to describe subregions of the subthalamic space where neurostimulation has a positive effect on gait or provokes gait disturbances in Parkinson’s disease.

Methods: Seventy-eight patients were classified according to postoperative changes in gait: (1) gait improvement, (2) no change, (3) de-novo gait disturbances. We performed a segregation analysis for (1) and (3) by simulating volumes of tissue activated and comparing aggregated spatial data for the two groups. We also calculated a probability map of therapy effects on gait.

Results: Twenty patients experienced complete remission of presurgical gait problems after STN-DBS. Nine patients showed de-novo gait disturbances one year after implantation. We observed no differences in stimulation parameters and control of global motor symptoms between groups. Active contacts were more ventrally located for de-novo gait disturbances vs. gait improvement. Strong correlations were found between clinical alterations in gait and the individual stimulation volume within the probabilistic outcome atlas (R2=0.78; p=0.01). The heatmap allowed patients to be notified of the likelihood to experience long-term gait benefits based on their volume of tissue activated overlap.

Conclusion: Distinct areas within the subthalamic nucleus correlate with gait improvement vs. de-novo gait disorders after neurostimulation. Our heatmap model showed a high correlation for therapy outcomes, especially gait improvement. Interestingly, the concept of sweet spots or bad spots could not explain individual differences. The thin delineations between close substructures in the subthalamic nucleus correlated with individual changes in gait. The gait heatmap model may direct future re-programming approaches for more mobility in Parkinsonian patients.