NIGRASTEER

Lateral steering of nigral stimulation for freezing of gait in Parkinson's disease

01/02/2018 to 31/01/2021

Substantial efforts are ongoing in order to establish nigral stimulation for freezing of gait in Parkinson’s disease resistant to standard therapy. Currently, freezing of gait represents a largely unmet therapeutic need in intermediate and advanced disease stages and severely deteriorates quality of life. A multicentre trial is ongoing to this end (NCT02588144; Investigator-initiated trial, coordinated by the Tübingen Centre). Nevertheless, the technological advancement from directional steering enables now to explore functional subterritories in the substantia nigra in order to improve i) efficacy, ii) safety, and to facilitate iii) future neurosurgical targeting approaches when referring to nigral subterritories in addition to standard STN stimulation. Moreover, intraoperative electrophysiological surrogates obtained from the directional lead (local field potentials, evoked potentials), as well as its connectivity to the cortical surface (EEG), are expected to inform neurosurgeons and neurologists on optimal lead placement and postoperative programming, given that electrophysiological signatures like oscillatory activity or neuronal synchronization present with substantial abnormality in freezing of gait. With this proposal, we expect to facilitate the concept of nigral stimulation for freezing of gait by taking advantage from cutting-edge steering technology and multiple independent current sources.