Forced Exercise for Freezing of Gait in Post STN DBS Parkinson’s Disease Patients Vanessa K Hinson 1* , Amy Delambo 1 , Aaron E Embry 2 , Chris Gregory 2 , Kathryn Gaines 3 , Vicky Salak 4 and Gonzalo J Revuelta 1 1 Department of Neurosciences Medical University of South Carolina Charleston, SC, USA 2 Department of Health Sciences & Research Medical University of South Carolina Charleston, SC, USA 3 Aurora Advanced Health Care 3003 W. Good Hope Rd. Milwaukee, Wisconsin, USA 4 Coastal Carolina Medical Associates 1010 Medical Center Drive, Suite 240 Hardeeville, SC, USA * Corresponding author: Vanessa K. Hinson, 1 Department of Neurosciences Medical University of South Carolina Charleston, SC, USA, Tel: 843-792-7262; E-mail: hinsonvk@musc.edu Received date: Jul 15, 2014, Accepted date: Nov 12, 2014, Published date: Nov 19, 2014 Copyright: © 2014 Vanessa K. Hinson et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract Freezing of gait (FoG) is a debilitating condition experienced by Parkinson’s disease (PD) patients whereby they are episodically unable to walk despite their intention to do so. Early, it may occur in the OFF state, and responds to dopaminergic therapy and deep brain stimulation (DBS). FoG can also occur in the ON state, termed non-levodopa responsive FoG (NLR-FoG). The objective of this study was to determine the effects of a forced exercise treadmill protocol on NLR-FoG in patients with PD that had undergone DBS. We recruited five patients to complete a progressive treadmill-training program for six weeks. The freezing of gait questionnaire (FoG-Q) was the primary outcome measure. Patients also completed diaries documenting the number of freezing episodes and falls, the gait and falls questionnaire (GFQ), as well as PD motor and balance assessments pre and post treatment. Objective assessment of spatiotemporal gait parameters were also collected pre and post treatment. We did not see a significant difference in the FoG-Q pre and post treatment. We did see improvements in the MDS-UPDRS in 4/5 patients, and improvements in falls and freezing as measured by diaries in 3/5 patients. Improvement in spatiotemporal gait parameters beyond the minimal detectible change was seen in 2/5 patients. In conclusion, we found that a progressive forced exercise protocol is feasible in patients with PD post DBS, but response to treatment was not uniform. Further larger studies to elucidate factors predictive of response in this patient population are warranted. Keywords: Freezing of gait; Deep brain stimulation; Treadmill training; Exercise; Parkinson’s disease; Falls Introduction Freezing of gait (FoG) is defined as the episodic inability to produce effective stepping [1]. FoG commonly occurs when patients with Parkinson’s disease (PD) wear off from their dopaminergic medications. This type of freezing (OFF-FoG) is treated by strategies aimed at eliminating wearing off (including deep brain stimulation or DBS). OFF FoG responds well to available treatment, and is therefore not a therapeutic challenge [2,3]. Unfortunately, FoG can also occur in the ON state. This type of FoG is not responsive to dopaminergic therapies (termed non-levodopa responsive FoG or NLR-FoG) or DBS, and there currently is no effective therapy [1]. In general, FoG that occurs in patients who have undergone successful DBS is not levodopa responsive, making this population a good model to study NLR-FoG. Multiple studies have demonstrated feasibility, safety, and efficacy of treadmill training for the treatment of gait disturbances in PD. These studies have shown improvements in gait as well as motor symptoms and quality of life that were sustained, in some cases, for several weeks after cessation of treatment [4]. One study showed specific improvement in FoG with treadmill training, but did not differentiate levodopa responsive FoG from NLR-FoG [5]. More recently, a small series studied robot assisted treadmill training with improvement in freezing and other spatiotemporal parameters which was sustained up to six weeks after treatment cessation [6]. Another recent feasibility study used body weight supported high intensity treadmill training and showed improvement in some gait parameters as well as motor symptoms and quality of life. Despite the growing body of evidence showing safety, feasibility, and improvements in gait with treadmill training, few studies have specifically evaluated FoG, and none thus far has focused on NLR-FoG, which is the most significant therapeutic challenge in this patient population. The objective of our study was to determine the effects of Forced Exercise treadmill walking on NLR-FoG in patients with PD post sub- thalamic nucleus deep brain stimulation (STN-DBS). Materials and Methods Five subjects with a diagnosis of PD as determined by the UK Brain Bank Criteria were recruited for the study through a tertiary care Movement Disorders clinic. Patients between the ages of 40–75 with successful STN DBS implantation, on stable PD medications and STN DBS programming for >3 months were included. Patients had to have witnessed FoG at screening visit, and a mini-mental status examination (MMSE)>27 to exclude dementia. All patients underwent cardiac clearance including a pre-study exercise tolerance test in the Motion Analysis Laboratory monitored by a cardiologist and lab technician. Hinson VK et al., J Alzheimers Dis Parkinsonism 2014, 4:6 DOI: 10.4172/2161-0460.1000171 Research Article Open Access J Alzheimers Dis Parkinsonism ISSN:2161-0460 JADP, an open access journal Volume 4 • Issue 6 • 1000171 Journal of Alzheimer’s Disease & Parkinsonism J o u r n a l o f A l z h e i m e r s D i s e a s e & P a r k i n s o n i s m ISSN: 2161-0460