Effects of theta burst stimulation on the Parkinsonian gait disorder and cortical gait-network activity

BackgroundThe Parkinsonian gait disorder and freezing of gait (FoG) are challenging symptoms of Parkinson's disease (PD).ObjectiveTo assess the effect of subthalamic theta burst deep brain stimulation (TBS-DBS) on the Parkinsonian gait performance in real-world conditions and cortical activity indexed by mobile EEG.MethodsIn this monocentric, randomised, double-blind, short-term study, 12 age-matched controls (11 male, age 59 ± 8 years) and 15 PD participants (14 male, age 62 ± 9 years, disease duration 15 ± 6 years) with subthalamic stimulation (76 ± 39 months) were assessed with clinical scores (FoG-Course, MDS-UPDRS) and a standardized gait course simulating everyday life situations. Three DBS algorithms were applied in a randomized order with intertrial waiting periods of 30 min: (1) OFF-DBS; (2) cDBS; (3) TBS-DBS (interburst frequency 5 Hz, intraburst frequency 200 Hz) with regular medication. During the standardized gait course a mobile, 24-channel EEG system and 6 wearable axial kinematic sensors were used.ResultsThe primary outcome, the relative change of FoG-Course by DBS, was not superior with TBS-DBS compared to cDBS in the entire sample. Seven of fifteen PD participants rated subjectively TBS-DBS equal or better than cDBS ("TBS-preference group"). EEG recordings revealed movement-induced alpha and beta suppression in premotor and motor cortex in both cDBS and TBS-DBS conditions in PD with slightly different patterns between the DBS modes.ConclusionsIn this pilot trial, TBS-DBS showed benefits in the subjective perception of gait in a subgroup of PD patients accompanied by specific cortical network changes. TBS-DBS merits further investigation in future larger cohort studies with longer observation periods.