New onset on-medication freezing of gait after STN-DBS in Parkinson's disease

Shanshan Mei; Jiping Li; Erik H. Middlebrooks; Leonardo Almeida; Wei Hu; Yuqing Zhang; Adolfo Ramirez-Zamora; Piu Chan

doi:10.3389/fneur.2019.00659

New onset on-medication freezing of gait after STN-DBS in Parkinson's disease

Shanshan Mei, Jiping Li, Erik H. Middlebrooks, Leonardo Almeida, Wei Hu, Yuqing Zhang, Adolfo Ramirez-Zamora, Piu Chan

Research output: Contribution to journal › Article › peer-review

10 Scopus citations

Abstract

Freezing of gait (FoG) is commonly observed in advanced Parkinson's disease (PD) and it is associated with reduced mobility, recurrent falls, injuries, and loss of independence. This phenomenon typically occurs as the effect of dopaminergic medications wears off ("off" FoG) but on rare occasions, it can also be observed during peak medication effect ("on" FoG). In this report, we present the case of a 65-year-old female with a 13-year history of akinetic-rigid idiopathic PD who developed recurrent episodes of "on" FoG after bilateral subthalamic nucleus deep brain stimulation (STN-DBS). She underwent STN-DBS for management of motor fluctuations, which resulted in a marked improvement in her motor symptoms. Within the next 6 months and after several programming sessions, the patient reported "on" FoG occurring regularly 1 h after taking levodopa and lasting a few hours. Accordingly, a repeated levodopa challenge showed that FoG resolved with either levodopa administration or STN stimulation alone, but the combination of both therapies induced recurrence of FoG in our patient. Subsequent management was complex requiring adjustments in levodopa dose and formulation along with advanced DBS programming.

Original language	English (US)
Article number	659
Journal	Frontiers in Neurology
Volume	10
Issue number	JUN
DOIs	https://doi.org/10.3389/fneur.2019.00659
State	Published - 2019
Externally published	Yes

Bibliographical note

Funding Information:
Beijing Municipal Administration of Hospitals’ Mission Plan (No. SML20150803), Beijing Municipal Science & Technology Commission (Nos. D07050701130000, D07050701130701, Z161100000216140, and Z171100000117013), Beijing Municipal Commission of Health and Family Planning (No. PXM2018_026283_000002), and the National Key R&D Program of China (No. 2018YFC1312000).

Publisher Copyright:
© 2019 Mei, Li, Middlebrooks, Almeida, Hu, Zhang, Ramirez-Zamora and Chan.

Keywords

Cerebellum
Deep brain stimulation
Fiber tracking
Freezing of gait
On-state
Prefrontal cortex
Subthalamic nucleus

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10.3389/fneur.2019.00659

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title = "New onset on-medication freezing of gait after STN-DBS in Parkinson's disease",

abstract = "Freezing of gait (FoG) is commonly observed in advanced Parkinson's disease (PD) and it is associated with reduced mobility, recurrent falls, injuries, and loss of independence. This phenomenon typically occurs as the effect of dopaminergic medications wears off ({"}off{"} FoG) but on rare occasions, it can also be observed during peak medication effect ({"}on{"} FoG). In this report, we present the case of a 65-year-old female with a 13-year history of akinetic-rigid idiopathic PD who developed recurrent episodes of {"}on{"} FoG after bilateral subthalamic nucleus deep brain stimulation (STN-DBS). She underwent STN-DBS for management of motor fluctuations, which resulted in a marked improvement in her motor symptoms. Within the next 6 months and after several programming sessions, the patient reported {"}on{"} FoG occurring regularly 1 h after taking levodopa and lasting a few hours. Accordingly, a repeated levodopa challenge showed that FoG resolved with either levodopa administration or STN stimulation alone, but the combination of both therapies induced recurrence of FoG in our patient. Subsequent management was complex requiring adjustments in levodopa dose and formulation along with advanced DBS programming.",

keywords = "Cerebellum, Deep brain stimulation, Fiber tracking, Freezing of gait, On-state, Prefrontal cortex, Subthalamic nucleus",

author = "Shanshan Mei and Jiping Li and Middlebrooks, {Erik H.} and Leonardo Almeida and Wei Hu and Yuqing Zhang and Adolfo Ramirez-Zamora and Piu Chan",

note = "Funding Information: Beijing Municipal Administration of Hospitals{\textquoteright} Mission Plan (No. SML20150803), Beijing Municipal Science & Technology Commission (Nos. D07050701130000, D07050701130701, Z161100000216140, and Z171100000117013), Beijing Municipal Commission of Health and Family Planning (No. PXM2018_026283_000002), and the National Key R&D Program of China (No. 2018YFC1312000). Publisher Copyright: {\textcopyright} 2019 Mei, Li, Middlebrooks, Almeida, Hu, Zhang, Ramirez-Zamora and Chan.",

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doi = "10.3389/fneur.2019.00659",

language = "English (US)",

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AU - Mei, Shanshan

AU - Li, Jiping

AU - Middlebrooks, Erik H.

AU - Almeida, Leonardo

AU - Hu, Wei

AU - Zhang, Yuqing

AU - Ramirez-Zamora, Adolfo

AU - Chan, Piu

N1 - Funding Information: Beijing Municipal Administration of Hospitals’ Mission Plan (No. SML20150803), Beijing Municipal Science & Technology Commission (Nos. D07050701130000, D07050701130701, Z161100000216140, and Z171100000117013), Beijing Municipal Commission of Health and Family Planning (No. PXM2018_026283_000002), and the National Key R&D Program of China (No. 2018YFC1312000). Publisher Copyright: © 2019 Mei, Li, Middlebrooks, Almeida, Hu, Zhang, Ramirez-Zamora and Chan.

PY - 2019

Y1 - 2019

N2 - Freezing of gait (FoG) is commonly observed in advanced Parkinson's disease (PD) and it is associated with reduced mobility, recurrent falls, injuries, and loss of independence. This phenomenon typically occurs as the effect of dopaminergic medications wears off ("off" FoG) but on rare occasions, it can also be observed during peak medication effect ("on" FoG). In this report, we present the case of a 65-year-old female with a 13-year history of akinetic-rigid idiopathic PD who developed recurrent episodes of "on" FoG after bilateral subthalamic nucleus deep brain stimulation (STN-DBS). She underwent STN-DBS for management of motor fluctuations, which resulted in a marked improvement in her motor symptoms. Within the next 6 months and after several programming sessions, the patient reported "on" FoG occurring regularly 1 h after taking levodopa and lasting a few hours. Accordingly, a repeated levodopa challenge showed that FoG resolved with either levodopa administration or STN stimulation alone, but the combination of both therapies induced recurrence of FoG in our patient. Subsequent management was complex requiring adjustments in levodopa dose and formulation along with advanced DBS programming.

AB - Freezing of gait (FoG) is commonly observed in advanced Parkinson's disease (PD) and it is associated with reduced mobility, recurrent falls, injuries, and loss of independence. This phenomenon typically occurs as the effect of dopaminergic medications wears off ("off" FoG) but on rare occasions, it can also be observed during peak medication effect ("on" FoG). In this report, we present the case of a 65-year-old female with a 13-year history of akinetic-rigid idiopathic PD who developed recurrent episodes of "on" FoG after bilateral subthalamic nucleus deep brain stimulation (STN-DBS). She underwent STN-DBS for management of motor fluctuations, which resulted in a marked improvement in her motor symptoms. Within the next 6 months and after several programming sessions, the patient reported "on" FoG occurring regularly 1 h after taking levodopa and lasting a few hours. Accordingly, a repeated levodopa challenge showed that FoG resolved with either levodopa administration or STN stimulation alone, but the combination of both therapies induced recurrence of FoG in our patient. Subsequent management was complex requiring adjustments in levodopa dose and formulation along with advanced DBS programming.

KW - Cerebellum

KW - Deep brain stimulation

KW - Fiber tracking

KW - Freezing of gait

KW - On-state

KW - Prefrontal cortex

KW - Subthalamic nucleus

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ER -

New onset on-medication freezing of gait after STN-DBS in Parkinson's disease

Abstract

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