Lateralized Subthalamic Stimulation for Axial Dysfunction in Parkinson's Disease: A Randomized Trial

Karlo J Lizárraga; Bhairavei Gnanamanogaran; Tameem M Al-Ozzi; Melanie Cohn; George Tomlinson; Alexandre Boutet; Gavin J B Elias; Jürgen Germann; Derrick Soh; Suneil K Kalia; Mojgan Hodaie; Renato P Munhoz; Connie Marras; William D Hutchison; Andres M Lozano; Anthony E Lang; Alfonso Fasano

doi:10.1002/mds.28953

Lateralized Subthalamic Stimulation for Axial Dysfunction in Parkinson's Disease: A Randomized Trial

Mov Disord. 2022 May;37(5):1079-1087. doi: 10.1002/mds.28953. Epub 2022 Feb 13.

Authors

Karlo J Lizárraga^{1

2}, Bhairavei Gnanamanogaran^{1

3}, Tameem M Al-Ozzi^{3

4

5}, Melanie Cohn^{4

6}, George Tomlinson^{7

8}, Alexandre Boutet^{8

9

10}, Gavin J B Elias^{8

10}, Jürgen Germann^{8

10}, Derrick Soh^{1

11}, Suneil K Kalia^{4

10

12}, Mojgan Hodaie^{4

10}, Renato P Munhoz^{1

4}, Connie Marras^{1

4}, William D Hutchison^{4

5

10

12}, Andres M Lozano^{4

10}, Anthony E Lang^{1

4}, Alfonso Fasano^{1

4

12}

Affiliations

¹ The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Hospital Network and Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
² Motor Physiology and Neuromodulation Program, Division of Movement Disorders, Department of Neurology and Center for Health and Technology, University of Rochester, Rochester, New York, USA.
³ University of Toronto, Toronto, Ontario, Canada.
⁴ Krembil Research Institute, Toronto, Ontario, Canada.
⁵ Departments of Surgery and Physiology, University of Toronto, Toronto, Ontario, Canada.
⁶ Department of Psychology, University of Toronto, Toronto, Ontario, Canada.
⁷ Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
⁸ University Health Network, Toronto, Ontario, Canada.
⁹ Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada.
¹⁰ Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Ontario, Canada.
¹¹ Alfred Hospital, Melbourne, Victoria, Australia.
¹² Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, Ontario, Canada.

PMID: 35156734
DOI: 10.1002/mds.28953

Abstract

Background: Patients with Parkinson's disease might develop treatment-resistant axial dysfunction after bilateral subthalamic stimulation.

Objectives: To study whether lateralized stimulation (unilateral 50% amplitude reduction) for ≥21 days results in ≥0.13 m/s faster gait velocity in the dopaminergic ON state in these patients, and its effects on motor and axial function, quantitative gait and speech measures, quality of life, and selected cognitive tasks.

Methods: Randomized, double-blinded, double-crossover trial.

Results: In 22 participants (51-79 years old, 15 women), there were no significant changes in gait velocity, quality of life, cognitive, and speech measures. Reducing left-sided amplitude resulted in a 2.5-point improvement in axial motor Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) (P = 0.005, uncorrected) and a 1.9-point improvement in the Freezing of Gait Questionnaire (P = 0.024, uncorrected).

Conclusions: Lateralized subthalamic stimulation does not result in meaningful improvement in gait velocity in patients with Parkinson's disease who develop treatment-resistant axial dysfunction after bilateral subthalamic stimulation. Left subthalamic overstimulation may contribute to axial deterioration in these patients. © 2022 International Parkinson and Movement Disorder Society.

Trial registration: ClinicalTrials.gov NCT03462082.

Keywords: Parkinson's disease; asymmetry; axial motor function; deep brain stimulation; lateralization.

Publication types

Randomized Controlled Trial
Research Support, N.I.H., Extramural

MeSH terms

Aged
Deep Brain Stimulation* / methods
Female
Gait Disorders, Neurologic* / etiology
Gait Disorders, Neurologic* / therapy
Humans
Middle Aged
Parkinson Disease* / complications
Parkinson Disease* / therapy
Quality of Life
Subthalamic Nucleus* / physiology
Treatment Outcome

Associated data

ClinicalTrials.gov/NCT03462082

Abstract

Publication types

MeSH terms

Associated data

Grants and funding