Deep Brain Stimulation of the Cuneiform Nucleus for Levodopa-resistant Freezing of Gait in Parkinson's Disease
Deep Brain Stimulation of the Cuneiform Nucleus for Levodopa-resistant Freezing of Gait in Parkinson's Disease
The purpose of this research study is to determine if DBS is a safe and effective therapy for
 severe freezing of gait in patients with Parkinson's Disease. Freezing of gait (FOG) is a
 particularly debilitating motor deficit seen in a subset of patients with Parkinson's Disease
 (PD).
Inclusion:

 1. Confirmed Parkinson's Disease according to movement disorder neurologist with
 documented exclusion of other disorders such as fronto-temporal dementia (FTD)/
 frontal gait disorder/normal pressure hydrocephalus (NPH)/progressive supranuclear
 palsy (PSP)

 2. PD stage3 ON medication, with severe gait dysfunction and predominant axial symptoms:
 Movement Disorder Society-Unified Parkinson's Disease Rating Scale Tremor Dominant
 (MDS-UPDRS TD), Postural Instability Gait Difficulty (PIGD) ratio ≤ 0.90 and Freezing
 Of Gait Questionnaire (FOGQ) score > 12.

 3. Age 40-75 with good response to Levodopa (defined as greater than 20% improvement in
 UPDRS score)

 4. FOG refractory to LEVODOPA>600 mg

 5. Insignificant tremor, bradykinesia, and rigidity symptoms, and poor candidate for Sub
 Thalamic Nucleus (STN) or Globus Pallidus Interna (GPi) DBS

 Exclusion:

 1. Individuals with major executive dysfunction

 2. Individuals with dementia, as defined by the Mattis Dementia Rating Scale-2 (DRS-2)
 score ≤ 130

 3. Individuals with other neurocognitive impairments

 4. Individuals who have depression, as defined for example by the Beck Depression
 Inventory II (BDI-II) > 25

 5. Presence of major medical co-morbidities and other surgical contra-indications such as
 coagulopathy

 6. Individuals who require diathermy, transcranial magnetic stimulation (TMS), or
 electroconvulsive therapy (ECT)

 7. Individuals with a history of prior intracranial surgery

 8. Individuals with a metallic implant in their head that is not MRI compatible (e.g.,
 aneurysm clip, cochlear implant)

 9. Individuals with active implantable devices anywhere in the body (e.g. cardiac
 pacemaker, defibrillator, spinal cord stimulator, implanted medication pump)

 10. Individuals who are pregnancy or desire to become pregnant during the study

 11. Individuals who are breastfeeding12.