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Abstract Details

Crossover Trial of Asymmetric Subthalamic Stimulation for Axial Dysfunction in Parkinson’s Disease
Movement Disorders
P7 - Poster Session 7 (5:30 PM-6:30 PM)
5-005

To evaluate whether asymmetric subthalamic deep brain stimulation (STN-DBS) is associated with axial dysfunction in patients with Parkinson’s disease (PD).

Treatment-resistant axial dysfunction is evident in 20-25% patients with PD after bilateral STN-DBS. Since the right hemisphere might be dominant for axial control, bilateral STN-DBS based on appendicular symptoms may contribute to axial dysfunction in these patients.

In a randomized, quadruple-blinded, double-crossover, comparative efficacy trial, we measured the effects of 3-4 weeks of bilateral, left-STN 50% voltage reduction (left-reduced) and right-STN 50% voltage reduction (right-reduced) on axial dysfunction in 22 PD patients with treatment-resistant postural instability gait dysfunction (PIGD) and freezing of gait (FOG) between 6 months and 5 years after STN-DBS surgery (i.e. FOG and UPDRS-PIGD score >6 despite medical and bilateral STN-DBS optimization). The primary outcome was gait speed (10-meter walk test). Secondary outcomes were MiniBESTest, UPDRS-PIGD, quantitative gait analysis, FOG-questionnaire, quantitative speech, MDS-UPDRS, selected cognitive tasks and 39-item PD questionnaire. We explored correlations with clinical and electrophysiological evidence for hemispheric differences in pre- and post-surgical motor control, PD severity, surgical approach and volume of tissue activated by STN-DBS.

There were no differences in gait speed, quantitative speech and cognitive tasks between bilateral, left-reduced and right-reduced-STN-DBS. Left-reduced-STN-DBS improved MiniBEST (1.6 points, p=0.067), UPDRS-PIGD (1.4 points, p=0.05), MDS-UPDRS-III-axial (3.5 points, p=0.005), MDS-UPDRS-III-gait (1.2 points, p=0.008) and FOG-questionnaire (1.9 points, p=0.024). Right-reduced-STN-DBS worsened MDS-UPDRS (10 points, p=0.031) and MDS-UPDRS-III (4.6 points, p=0.039). Voltage reduction contralateral to shorter step length improved UPDRS-PIGD by 1.5 points (p=0.037), MDS-UPDRS-III-axial by 2.4 points (p=0.006) and MDS-UPDRS-III-gait by 1 point (p=0.023). Voltage reduction contralateral to longer step length worsened MDS-UPDRS by 10.2 points (p=0.029) and MDS-UPDRS-III by 5.2 points (p=0.02).

Bilateral STN-DBS optimization based on appendicular motor symptoms could lead to axial dysfunction due to left-STN overstimulation in PD.
Authors/Disclosures
Karlo J. Lizarraga, MD, MS, FÂ鶹´«Ã½Ó³»­ (University of Rochester)
PRESENTER 		Dr. Lizarraga has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for FHC. The institution of Dr. Lizarraga has received research support from BlueRock. The institution of Dr. Lizarraga has received research support from Roche. The institution of Dr. Lizarraga has received research support from NIH/NINDS. Dr. Lizarraga has received personal compensation in the range of $500-$4,999 for serving as a Speaker with International Parkinson and Movement Disorders Society. Dr. Lizarraga has received personal compensation in the range of $0-$499 for serving as a Reviewer with National Institutes of Health. Dr. Lizarraga has a non-compensated relationship as a Editorial Board Member for Brain & Life with Â鶹´«Ã½Ó³»­ that is relevant to Â鶹´«Ã½Ó³»­ interests or activities.
No disclosure on file
No disclosure on file
Melanie Cohn (University of Toronto Scarborough) No disclosure on file
No disclosure on file
Alexandre Boutet No disclosure on file
No disclosure on file
No disclosure on file
Renato P. Munhoz, MD, PhD Dr. Munhoz has nothing to disclose.
Connie C. Marras, MD (Toronto Western Hospital) Dr. Marras has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Neurocrine Biosciences. The institution of Dr. Marras has received research support from Theravance Inc. The institution of Dr. Marras has received research support from Centogene.
No disclosure on file
Andres M. Lozano, MD (Toronto Western Hosp) Dr. Lozano has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Abbott. Dr. Lozano has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Insightec. Dr. Lozano has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Boston Scientific. Dr. Lozano has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Medtronic. Dr. Lozano has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Functional Neuromodulation.
Anthony E. Lang, MD, FÂ鶹´«Ã½Ó³»­ (Toronto Western Hospital) Dr. Lang has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for AbbVie, Amylyx, Aprinoia, Biogen, BioAdvance, Biohaven, BioVie, BlueRock, BMS, Denali, Janssen, Lilly, Pharma 2B, Sun Pharma, and UCB. Dr. Lang has received personal compensation in the range of $50,000-$99,999 for serving as an Expert Witness for medicolegal cases related to paraquat. The institution of Dr. Lang has received research support from AbbVie. Dr. Lang has received intellectual property interests from a discovery or technology relating to health care. Dr. Lang has received publishing royalties from a publication relating to health care.
Alfonso Fasano, MD, PhD, FÂ鶹´«Ã½Ó³»­ (Toronto Western Hospital - U of Toronto) Dr. Fasano has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Abbott. Dr. Fasano has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Abbvie. Dr. Fasano has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ipsen. Dr. Fasano has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Medtronic. Dr. Fasano has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Boston Scientific. Dr. Fasano has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Abbott. Dr. Fasano has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Medtronic. Dr. Fasano has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Ceregate. Dr. Fasano has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Inbrain Neuroelectronics. Dr. Fasano has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Syneos Health. Dr. Fasano has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Annovis. Dr. Fasano has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for CADTH. Dr. Fasano has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for International Parkinson and Movement Disorders Society. The institution of Dr. Fasano has received research support from Boston Scientific. The institution of Dr. Fasano has received research support from Medtronic. The institution of Dr. Fasano has received research support from Abbvie. The institution of Dr. Fasano has received research support from Canadian Institutes of Health Research (CIHR). The institution of Dr. Fasano has received research support from Michael J Fox Foundation. The institution of Dr. Fasano has received research support from Bluerock Therapeutics. Dr. Fasano has received publishing royalties from a publication relating to health care. Dr. Fasano has a non-compensated relationship as a Medical Advisory Committee with CenteR for Advancing Neurological Innovation to Application (CRANIA) that is relevant to Â鶹´«Ã½Ó³»­ interests or activities. Dr. Fasano has a non-compensated relationship as a Medical Advisory Committee with HopeNET that is relevant to Â鶹´«Ã½Ó³»­ interests or activities. Dr. Fasano has a non-compensated relationship as a Medical Advisory Committee with International Essential Tremor Foundation that is relevant to Â鶹´«Ã½Ó³»­ interests or activities. Dr. Fasano has a non-compensated relationship as a Member with Tremor Research Group that is relevant to Â鶹´«Ã½Ó³»­ interests or activities. Dr. Fasano has a non-compensated relationship as a Co-Chair with Tremor Study Group of the IPMDS that is relevant to Â鶹´«Ã½Ó³»­ interests or activities. Dr. Fasano has a non-compensated relationship as a Vice-Chair with NPH Study Group of the IPMDS that is relevant to Â鶹´«Ã½Ó³»­ interests or activities. Dr. Fasano has a non-compensated relationship as a Vice-Chair with Industry Committee of the IPMDS that is relevant to Â鶹´«Ã½Ó³»­ interests or activities.