Spinal cord stimulation for gait disturbances in Parkinson’s disease

ABSTRACT

Introduction

Gait disturbances are a major contributor to the disability associated with Parkinson’s disease. Although pharmacologic therapies and deep brain stimulation improve most motor parkinsonian features, their effects on gait are highly variable. Spinal cord stimulation, typically used for the treatment of chronic pain, has emerged as a potential therapeutic approach to improve gait disturbances in Parkinson’s disease.

Areas covered

The authors review the available evidence on the effects of spinal cord stimulation in patients with Parkinson’s disease, targeting primarily gait abnormalities. They also discuss possible mechanisms, safety, and methodological implications for future clinical trials. This systematic review of originally published articles in English language was performed using The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA).

Expert opinion

Overall, there was a positive effect of spinal cord stimulation on gait outcomes in most studies. However, the open label study designs limited the ability to characterize the independent effects of spinal cord stimulation in patients with Parkinson’s disease. Also, optimal levels of implantation and stimulation paradigms remain to be determined. Future research seeking to understand these fundamental pieces of information may help in the formulation, design, and interpretation of pivotal clinical trials of spinal cord stimulation for Parkinson’s disease.

KEYWORDS:

• Parkinson’s Disease
• Gait
• Neuromodulation
• Spinal Cord Stimulation

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Correction

Acknowledgments

The authors thank Nicole Provenza, PhD, for her support with figure design.

Declaration of interest

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

The authors are funded by Baylor College of Medicine.