This study aims to evaluate the effectiveness of spinal cord stimulation (SCS) in treating two patients with atypical Parkinson"s disease characterized by primary progressive freezing of gait (PPFoG), a rare and challenging motor symptom that is resistant to conventional treatments. Both patients exhibited severe mobility limitations due to PPFoG and were considered for SCS as an alternative therapeutic approach.
Two patients with diagnosed PPFoG, unresponsive to pharmacological and other conventional interventions, underwent SCS therapy. Patient 1 presented with a 6-year history of progressive gait freezing and poor response to dopaminergic medication. Patient 2 had a 5-year history of freezing of gait associated with atypical features. SCS electrodes were implanted at the thoracic level targeting gait control pathways. Clinical outcomes were assessed using gait analysis, the Unified Parkinson"s Disease Rating Scale, Timed "Up and Go" test, Berg Balance Scale, and patient-reported outcomes on freezing episodes. Both patients were followed up for 12 months to assess long-term outcomes.
Both patients experienced initial improvements in freezing following SCS implantation. Patient 1 showed a marked reduction in freezing episodes and better gait stability, while patient 2 reported improved mobility, particularly in initiating movement, within the first 3 months after implantation. However, the positive effects of SCS were not sustained. Over time, both patients experienced a gradual return of freezing episodes and worsening mobility. By the 12-month follow-up, the stimulation no longer provided meaningful benefits, and both patients reported a decline in quality of life compared to baseline. As a result, the SCS devices were explanted.
SCS may offer short-term benefits for patients with PPFoG, particularly in improving freezing and mobility during the early post-implantation period. However, the long-term efficacy of SCS in such cases is limited, without sustained benefits. Larger studies are necessary to explore the underlying mechanisms of the transient improvements and to identify strategies for achieving more durable outcomes with SCS.