Effects of spinal cord stimulation on postural control in Parkinson's disease patients with freezing of gait

  1. Andrea Cristina de Lima-Pardini  Is a corresponding author
  2. Daniel Boari Coelho  Is a corresponding author
  3. Carolina Pinto Souza
  4. Carolina Oliveira Souza
  5. Maria Gabriela dos Santos Ghilardi
  6. Tiago Garcia
  7. Mariana Voos
  8. Matija Milosevic
  9. Clement Hamani
  10. Luis Augusto Teixeira
  11. Erich Talamoni Fonoff  Is a corresponding author
  1. Federal University of ABC, Brazil
  2. University of São Paulo, Brazil
  3. University of Tokyo, Japan
  4. University of Toronto, Canada

Abstract

Freezing of gait (FoG) in Parkinson's disease (PD) is an incapacitating transient phenomenon, followed by continuous postural disorders. Spinal cord stimulation (SCS) is a promising intervention for FoG in patients with PD, however its effects on distinct domains of postural control is not well known. The aim of this study is to assess the effects of SCS on FoG and distinct domains of postural control. Four patients with FoG were implanted with SCS systems in the upper thoracic spine. Anticipatory postural adjustment (APA), reactive postural responses, gait and FoG were biomechanically assessed. In general, the results showed that SCS improved FoG and APA. However, SCS failed to improve reactive postural responses. SCS seems to influence cortical motor circuits, involving the supplementary motor area. On the other hand, reactive posture control to external perturbation that mainly relies on neuronal circuitries involving the brainstem and spinal cord, is less influenced by SCS.

Data availability

All data generated or analysed during this study are included in the manuscript and supporting files. Source data files have been provided for Figures 1 and 2.

Article and author information

Author details

  1. Andrea Cristina de Lima-Pardini

    Centre of Mathematics, Computation and Cognition, Federal University of ABC, São Bernardo do Campo, Brazil
    For correspondence
    andrea.cristina@ufabc.edu.br
    Competing interests
    The authors declare that no competing interests exist.
  2. Daniel Boari Coelho

    Human Motor Systems Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
    For correspondence
    daniel.boari@ufabc.edu.br
    Competing interests
    The authors declare that no competing interests exist.
    ORCID icon "This ORCID iD identifies the author of this article:" 0000-0001-8758-6507
  3. Carolina Pinto Souza

    Department of Neurology, University of São Paulo, São Paulo, Brazil
    Competing interests
    The authors declare that no competing interests exist.
  4. Carolina Oliveira Souza

    Department of Neurology, University of São Paulo, São Paulo, Brazil
    Competing interests
    The authors declare that no competing interests exist.
  5. Maria Gabriela dos Santos Ghilardi

    Department of Neurology, University of São Paulo, São Paulo, Brazil
    Competing interests
    The authors declare that no competing interests exist.
  6. Tiago Garcia

    Department of Neurology, University of São Paulo, São Paulo, Brazil
    Competing interests
    The authors declare that no competing interests exist.
  7. Mariana Voos

    Department of Physical Therapy, Speech and Occupational Therapy, University of São Paulo, São Paulo, Brazil
    Competing interests
    The authors declare that no competing interests exist.
  8. Matija Milosevic

    Department of Life Sciences, Graduate School of Arts and Sciences, University of Tokyo, Tokyo, Japan
    Competing interests
    The authors declare that no competing interests exist.
  9. Clement Hamani

    Division of Neurosurgery, Sunnybrook Research Institute, University of Toronto, Toronto, Canada
    Competing interests
    The authors declare that no competing interests exist.
  10. Luis Augusto Teixeira

    Human Motor Systems Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
    Competing interests
    The authors declare that no competing interests exist.
  11. Erich Talamoni Fonoff

    Department of Neurology, University of São Paulo, São Paulo, Brazil
    For correspondence
    fonoffet@usp.br
    Competing interests
    The authors declare that no competing interests exist.

Funding

Hospital das Clinicas, University of São Paulo Medical School

  • Erich Talamoni Fonoff

Brazilian Council of Science and Technology

  • Luis Augusto Teixeira

São Paulo Research Foundation

  • Luis Augusto Teixeira

The funders had no role in study design, data collection and interpretation, or the decision to submit the work for publication.

Ethics

Human subjects: The study was approved by the department review board and in the ethics committee atHospital das Clinicas of University of São Paulo and registered in the national clinicalresearch database (CAPPESQ-HCFMUSP #12690213.0.0000.0068), which requires allparticipants to be previously instructed about the procedures and to give written informedconsent prior to study inclusion. Patients included in the present study participated in theclinical trial also registered in the clinicaltrials.gov (#NCT02388204). All experiments wereperformed in accordance with the Declaration of Helsinki

Reviewing Editor

  1. Amol Yadav, Duke University

Publication history

  1. Received: April 19, 2018
  2. Accepted: July 28, 2018
  3. Accepted Manuscript published: August 2, 2018 (version 1)
  4. Version of Record published: August 14, 2018 (version 2)

Copyright

© 2018, de Lima-Pardini et al.

This article is distributed under the terms of the Creative Commons Attribution License permitting unrestricted use and redistribution provided that the original author and source are credited.

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  1. Andrea Cristina de Lima-Pardini
  2. Daniel Boari Coelho
  3. Carolina Pinto Souza
  4. Carolina Oliveira Souza
  5. Maria Gabriela dos Santos Ghilardi
  6. Tiago Garcia
  7. Mariana Voos
  8. Matija Milosevic
  9. Clement Hamani
  10. Luis Augusto Teixeira
  11. Erich Talamoni Fonoff
(2018)
Effects of spinal cord stimulation on postural control in Parkinson's disease patients with freezing of gait
eLife 7:e37727.
https://doi.org/10.7554/eLife.37727

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