VANCOUVER—Spinal cord stimulation improves gait in patients with advanced Parkinson’s disease,
according to a pilot study described at the 21st International Congress of Parkinson’s Disease and Movement
Disorders. The technique allows neurologists to determine which stimulation parameters provide the greatest
benefit for each patient, said Mandar Jog, MD, Professor of Neurology and Engineering and Director of the
Movement Disorders Center at Western University in
“Each participant demonstrated unique gait changes
due to different spinal cord stimulation combinations,”
the investigators said. Many variables affect gait, such
as stride width, length, and velocity. “Instead of simply
measuring those variables as an outcome, we used those
variables to help us program the device,” said Dr. Jog.
Gait dysfunction and freezing of gait are common in
advanced Parkinson’s disease, and gait symptoms
are largely resistant to dopamine replacement therapy. Studies have suggested that epidural spinal cord
stimulation, which is an approved therapy for pain,
may help treat levodopa-resistant motor symptoms in
Dr. Jog and colleagues analyzed objective gait measurements to understand which spinal cord stimulation
settings most improved gait. They tested combinations
of pulse widths and frequencies that induced paresthesia in patients’ lower limbs.
The six-month study included five men with Parkin-
son’s disease who had significant gait disturbances on le-
vodopa therapy. The patients were not eligible for deep
brain stimulation. Mean age was 71, and mean disease du-
ration was 14 years. The patients underwent mid-thoracic
spinal cord stimulation surgery, and a dorsal spinal cord
stimulator was implanted in
the epidural space (T7–10).
The researchers evaluated
patients before the operation
and at weeks 2, 4, 6, 8, 10,
12, 16, and 24 after surgery.
The investigators con-
ducted randomized test-
ing of different spinal cord
stimulation settings at
weeks 2, 4, 6, 8, 10, 12, and
16. At week 24, researchers
evaluated patients when they had been off stimulation
for 48 hours and then with stimulation.
Patients completed walking tasks on a 20-foot walkway with sensors that relayed each footfall to a computer
with gait analysis software. The researchers grouped gait
variables according to whether they were expected to
increase with improvement (eg, step length and stride
velocity) or decrease with improvement (eg, stride width
and step time).
Determining Optimal Settings
For two of the patients, the most effective spinal cord
stimulation setting was a pulse width of 400 μs and a
frequency of 60 Hz. The optimal settings for the remaining three patients were 300 μs and 30 Hz, 300 μs and
130 Hz, and 300 or 400 μs and 130 Hz.
Key gait variables improved with spinal cord stimulation. For instance, stride velocity significantly improved
by 54% with the optimal settings, compared with baseline. Mean number of freezing of gait episodes significantly decreased. Unified Parkinson’s Disease Rating
Scale motor scores and patients’ confidence in performing activities of daily living also significantly improved,
compared with baseline.
Spinal Cord Stimulation May
Improve Gait in Patients With
Advanced Parkinson’s Disease
In a pilot study, spinal cord stimulation significantly increased patients’ confidence in
performing activities of daily living and decreased freezing of gait episodes.
Mandar Jog, MD