Objective Advanced Parkinson's Disease (PD) is associated with Parkinson’s Disease gait impairment (PDg), which increases the risk for falls and is often treatment-refractory. Subthalamic nucleus (STN) and globus pallidus pars interna (GPi) deep brain stimulation (DBS) often fails to improve axial symptoms like PDg. Spinal cord stimulation (SCS) has been suggested to improve PDg. SCS may benefit PDg by disrupting pathologic beta-oscillations and hypersynchrony in cortico-striatal-thalamic circuits to override excessive inhibition of brainstem locomotor regions. SCS may potentially improve locomotion by acting at any of these levels, either alone or in combination. Methods We conducted a comprehensive literature search and scoping review, identifying 106 patients in whom SCS was evaluated for PDg. Results Among the identified patients, 63% carried a pain diagnosis. Overall, the most common stimulation location was thoracic (78%), most commonly T9-T10. Burst (sub-perception) was the most common stimulation modality (59%). Prior treatment with DBS was used in 25%. Motor outcomes were assessed by the Unified Parkinson Disease Rating Scale (UPDRS) III-motor, UPDRS, the Timed Up and Go (TUG), and/or 10-/20-meter walking tests. Among these patients, 95 (90%) had PDg amelioration and improved motor outcomes. Conclusions Despite small sample sizes, patient heterogeneity, and unblinded evaluations complicating interpretations of efficacy and safety, SCS may be beneficial for at least a subset of PDg. Further research is required to clarify the role of SCS for PDg and the patients most suitable to benefit from this intervention.

中文翻译：

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脊髓刺激治疗帕金森病步态障碍：范围审查和机制考虑

目的 晚期帕金森病 (PD) 与帕金森病步态障碍 (PDg) 相关，后者会增加跌倒的风险，并且通常难以治疗。丘脑底核 (STN) 和苍白球内部 (GPi) 深部脑刺激 (DBS) 通常无法改善 PDg 等中轴症状。有人建议脊髓刺激 (SCS) 可以改善 PDg。SCS 可能通过破坏皮质-纹状体-丘脑回路中的病理性 β 振荡和超同步来克服脑干运动区域的过度抑制，从而使 PDg 受益。SCS 可以通过单独或组合地作用于这些水平中的任何一个来潜在地改善运动。方法 我们进行了全面的文献检索和范围审查，确定了 106 名接受过 SCS PDg 评估的患者。结果 在已识别的患者中，63% 的患者有疼痛诊断。总体而言，最常见的刺激位置是胸部 (78%)，最常见的是 T9-T10。突发（亚感知）是最常见的刺激方式（59%）。25% 的患者使用过 DBS 治疗。运动结果通过统一帕金森病评定量表 (UPDRS) III 运动、UPDRS、计时起行 (TUG) 和/或 10 米/20 米步行测试进行评估。在这些患者中，95 名 (90%) 的 PDg 得到改善，运动结果也得到改善。结论 尽管样本量小、患者异质性以及非盲评估使疗效和安全性的解释变得复杂，但 SCS 可能对至少一部分 PDg 有益。需要进一步的研究来阐明 SCS 对 PDg 的作用以及最适合从这种干预中受益的患者。