A Pragmatic Review on Spinal Cord Stimulation Therapy for Parkinson's Disease Gait Related Disorders: Gaps and Controversies

Victor Hvingelby; Rafael B. Carra; Miriam Højholt Terkelsen; Clement Hamani; Tamine Capato; Zuzana Košutzká; Joachim K. Krauss; Elena Moro; Nicola Pavese; Rubens G. Cury; Gait Study Group

doi:10.1002/mdc3.14143

A Pragmatic Review on Spinal Cord Stimulation Therapy for Parkinson's Disease Gait Related Disorders: Gaps and Controversies

Victor Hvingelby, Rafael B. Carra, Miriam Højholt Terkelsen, Clement Hamani, Tamine Capato, Zuzana Košutzká, Joachim K. Krauss, Elena Moro, Nicola Pavese, Rubens G. Cury^*, Gait Study Group

^*Corresponding author for this work

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Review › Research › peer-review

Abstract

Background: Parkinson's Disease (PD) is a progressive neurological disorder that results in potentially debilitating mobility deficits. Recently, spinal cord stimulation (SCS) has been proposed as a novel therapy for PD gait disorders. The highest levels of evidence remain limited for SCS. Objectives: In this systematic review and narrative synthesis, the literature was searched using combinations of key phrases indicating spinal cord stimulation and PD. Methods: We included pre-clinical studies and all published clinical trials, case reports, conference abstracts as well as protocols for ongoing clinical trials. Additionally, we included trials of SCS applied to atypical parkinsonism. Results: A total of 45 human studies and trials met the inclusion criteria. Based on the narrative synthesis, a number of knowledge gaps and future avenues of potential research were identified. This review demonstrated that evidence for SCS is currently not sufficient to recommend it as an evidence-based therapy for PD related gait disorders. There remain challenges and significant barriers to widespread implementation, including issues regarding patient selection, effective outcome selection, stimulation location and mode, and in programming parameter optimization. Results of early randomized controlled trials are currently pending. SCS is prone to placebo, lessebo and nocebo as well as blinding effects which may impact interpretation of outcomes, particularly when studies are underpowered. Conclusion: Therapies such as SCS may build on current evidence and be shown to improve specific gait features in PD. Early negative trials should be interpreted with caution, as more evidence will be required to develop effective methodologies in order to drive clinical outcomes.

Original language	English
Journal	Movement Disorders Clinical Practice
Volume	11
Issue	8
Pages (from-to)	927-947
Number of pages	21
ISSN	2330-1619
DOIs	https://doi.org/10.1002/mdc3.14143
Publication status	Published - Aug 2024

Keywords

falls
freezing of gait
gait disorder
neuromodulation
Parkinson's disease
spinal cord stimulation

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10.1002/mdc3.14143

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Hvingelby, V., Carra, R. B., Terkelsen, M. H., Hamani, C., Capato, T., Košutzká, Z., Krauss, J. K., Moro, E., Pavese, N., Cury, R. G., & Gait Study Group (2024). A Pragmatic Review on Spinal Cord Stimulation Therapy for Parkinson's Disease Gait Related Disorders: Gaps and Controversies. Movement Disorders Clinical Practice, 11(8), 927-947. https://doi.org/10.1002/mdc3.14143

@article{f75fe4d95b824ae8848c78df31f67772,

title = "A Pragmatic Review on Spinal Cord Stimulation Therapy for Parkinson's Disease Gait Related Disorders: Gaps and Controversies",

abstract = "Background: Parkinson's Disease (PD) is a progressive neurological disorder that results in potentially debilitating mobility deficits. Recently, spinal cord stimulation (SCS) has been proposed as a novel therapy for PD gait disorders. The highest levels of evidence remain limited for SCS. Objectives: In this systematic review and narrative synthesis, the literature was searched using combinations of key phrases indicating spinal cord stimulation and PD. Methods: We included pre-clinical studies and all published clinical trials, case reports, conference abstracts as well as protocols for ongoing clinical trials. Additionally, we included trials of SCS applied to atypical parkinsonism. Results: A total of 45 human studies and trials met the inclusion criteria. Based on the narrative synthesis, a number of knowledge gaps and future avenues of potential research were identified. This review demonstrated that evidence for SCS is currently not sufficient to recommend it as an evidence-based therapy for PD related gait disorders. There remain challenges and significant barriers to widespread implementation, including issues regarding patient selection, effective outcome selection, stimulation location and mode, and in programming parameter optimization. Results of early randomized controlled trials are currently pending. SCS is prone to placebo, lessebo and nocebo as well as blinding effects which may impact interpretation of outcomes, particularly when studies are underpowered. Conclusion: Therapies such as SCS may build on current evidence and be shown to improve specific gait features in PD. Early negative trials should be interpreted with caution, as more evidence will be required to develop effective methodologies in order to drive clinical outcomes.",

keywords = "falls, freezing of gait, gait disorder, neuromodulation, Parkinson's disease, spinal cord stimulation",

author = "Victor Hvingelby and Carra, {Rafael B.} and Terkelsen, {Miriam H{\o}jholt} and Clement Hamani and Tamine Capato and Zuzana Ko{\v s}utzk{\'a} and Krauss, {Joachim K.} and Elena Moro and Nicola Pavese and Cury, {Rubens G.} and Amal AlDakheel and Athanasia Alexoudi and Bloem, {Bastiaan R.} and Christian Blahak and Christopher Butson and Tamine Capato and Stephan Chabardes and Coyne, {Terry J.} and Rubens Cury and Bettina Debu and Thomas Foltynie and Eric Fonoff and Kelly Foote and Valerie Fraix and David Grabli and Alessandro Gulberti and Aline Haas and Clement Hamani and Etienne Hirsch and Fay Horak and William Hutchison and Carole Joint and Suneil Kalia and Un Kang and Zuzana Kosutzka and Corneliu Luca and Paolo Mazzone and Jill Ostrem and Okun, {Michael S.} and Monika Potter-Nerger and Neha Prakash and Delaram Safarpour and Nagaraja Sarangmat and Christopher Schrader and Silburn, {Peter A.} and S{\o}rensen, {Jens Christian Hedemann} and Alessandro Stefani and John Stein and Tai, {Chun Hwei} and Yen Tai and {Gait Study Group}",

year = "2024",

month = aug,

doi = "10.1002/mdc3.14143",

language = "English",

volume = "11",

pages = "927--947",

journal = "Movement Disorders Clinical Practice",

issn = "2330-1619",

publisher = "John Wiley and Sons Ltd",

number = "8",

}

Hvingelby, V, Carra, RB, Terkelsen, MH, Hamani, C, Capato, T, Košutzká, Z, Krauss, JK, Moro, E, Pavese, N, Cury, RG & Gait Study Group 2024, 'A Pragmatic Review on Spinal Cord Stimulation Therapy for Parkinson's Disease Gait Related Disorders: Gaps and Controversies', Movement Disorders Clinical Practice, vol. 11, no. 8, pp. 927-947. https://doi.org/10.1002/mdc3.14143

A Pragmatic Review on Spinal Cord Stimulation Therapy for Parkinson's Disease Gait Related Disorders: Gaps and Controversies. / Hvingelby, Victor; Carra, Rafael B.; Terkelsen, Miriam Højholt et al.
In: Movement Disorders Clinical Practice, Vol. 11, No. 8, 08.2024, p. 927-947.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Review › Research › peer-review

TY - JOUR

T1 - A Pragmatic Review on Spinal Cord Stimulation Therapy for Parkinson's Disease Gait Related Disorders

T2 - Gaps and Controversies

AU - Hvingelby, Victor

AU - Carra, Rafael B.

AU - Terkelsen, Miriam Højholt

AU - Hamani, Clement

AU - Capato, Tamine

AU - Košutzká, Zuzana

AU - Krauss, Joachim K.

AU - Moro, Elena

AU - Pavese, Nicola

AU - Cury, Rubens G.

AU - AlDakheel, Amal

AU - Alexoudi, Athanasia

AU - Bloem, Bastiaan R.

AU - Blahak, Christian

AU - Butson, Christopher

AU - Capato, Tamine

AU - Chabardes, Stephan

AU - Coyne, Terry J.

AU - Cury, Rubens

AU - Debu, Bettina

AU - Foltynie, Thomas

AU - Fonoff, Eric

AU - Foote, Kelly

AU - Fraix, Valerie

AU - Grabli, David

AU - Gulberti, Alessandro

AU - Haas, Aline

AU - Hamani, Clement

AU - Hirsch, Etienne

AU - Horak, Fay

AU - Hutchison, William

AU - Joint, Carole

AU - Kalia, Suneil

AU - Kang, Un

AU - Kosutzka, Zuzana

AU - Luca, Corneliu

AU - Mazzone, Paolo

AU - Ostrem, Jill

AU - Okun, Michael S.

AU - Potter-Nerger, Monika

AU - Prakash, Neha

AU - Safarpour, Delaram

AU - Sarangmat, Nagaraja

AU - Schrader, Christopher

AU - Silburn, Peter A.

AU - Sørensen, Jens Christian Hedemann

AU - Stefani, Alessandro

AU - Stein, John

AU - Tai, Chun Hwei

AU - Tai, Yen

AU - Gait Study Group

PY - 2024/8

Y1 - 2024/8

N2 - Background: Parkinson's Disease (PD) is a progressive neurological disorder that results in potentially debilitating mobility deficits. Recently, spinal cord stimulation (SCS) has been proposed as a novel therapy for PD gait disorders. The highest levels of evidence remain limited for SCS. Objectives: In this systematic review and narrative synthesis, the literature was searched using combinations of key phrases indicating spinal cord stimulation and PD. Methods: We included pre-clinical studies and all published clinical trials, case reports, conference abstracts as well as protocols for ongoing clinical trials. Additionally, we included trials of SCS applied to atypical parkinsonism. Results: A total of 45 human studies and trials met the inclusion criteria. Based on the narrative synthesis, a number of knowledge gaps and future avenues of potential research were identified. This review demonstrated that evidence for SCS is currently not sufficient to recommend it as an evidence-based therapy for PD related gait disorders. There remain challenges and significant barriers to widespread implementation, including issues regarding patient selection, effective outcome selection, stimulation location and mode, and in programming parameter optimization. Results of early randomized controlled trials are currently pending. SCS is prone to placebo, lessebo and nocebo as well as blinding effects which may impact interpretation of outcomes, particularly when studies are underpowered. Conclusion: Therapies such as SCS may build on current evidence and be shown to improve specific gait features in PD. Early negative trials should be interpreted with caution, as more evidence will be required to develop effective methodologies in order to drive clinical outcomes.

AB - Background: Parkinson's Disease (PD) is a progressive neurological disorder that results in potentially debilitating mobility deficits. Recently, spinal cord stimulation (SCS) has been proposed as a novel therapy for PD gait disorders. The highest levels of evidence remain limited for SCS. Objectives: In this systematic review and narrative synthesis, the literature was searched using combinations of key phrases indicating spinal cord stimulation and PD. Methods: We included pre-clinical studies and all published clinical trials, case reports, conference abstracts as well as protocols for ongoing clinical trials. Additionally, we included trials of SCS applied to atypical parkinsonism. Results: A total of 45 human studies and trials met the inclusion criteria. Based on the narrative synthesis, a number of knowledge gaps and future avenues of potential research were identified. This review demonstrated that evidence for SCS is currently not sufficient to recommend it as an evidence-based therapy for PD related gait disorders. There remain challenges and significant barriers to widespread implementation, including issues regarding patient selection, effective outcome selection, stimulation location and mode, and in programming parameter optimization. Results of early randomized controlled trials are currently pending. SCS is prone to placebo, lessebo and nocebo as well as blinding effects which may impact interpretation of outcomes, particularly when studies are underpowered. Conclusion: Therapies such as SCS may build on current evidence and be shown to improve specific gait features in PD. Early negative trials should be interpreted with caution, as more evidence will be required to develop effective methodologies in order to drive clinical outcomes.

KW - falls

KW - freezing of gait

KW - gait disorder

KW - neuromodulation

KW - Parkinson's disease

KW - spinal cord stimulation

UR - http://www.scopus.com/inward/record.url?scp=85196507246&partnerID=8YFLogxK

U2 - 10.1002/mdc3.14143

DO - 10.1002/mdc3.14143

M3 - Review

C2 - 38899557

AN - SCOPUS:85196507246

SN - 2330-1619

VL - 11

SP - 927

EP - 947

JO - Movement Disorders Clinical Practice

JF - Movement Disorders Clinical Practice

IS - 8

ER -

A Pragmatic Review on Spinal Cord Stimulation Therapy for Parkinson's Disease Gait Related Disorders: Gaps and Controversies

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Keywords

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