A new method for assessing the effectiveness of treatment of patients with gait disorders during spinal epidural neurostimulation

• Smirnov D.S.
• Paskhin D.L.
• Asratyan S.A.
• Pak V.V.
• Gorbachev K.V.

Abstract

Background. Gait disorder is one of the severe complications of nervous system diseases. Gait disorder can manifest itself as muscle weakness, spastic syndrome, and balance disorder. One of the methods for treating gait disorder is lumbar spinal cord stimulation (lSCS), where the first stage involves implantation of trail electrodes and evaluation of the method’s effectiveness, and if the result is positive, a permanent lSCS system is implanted. Current gait assessment methods are often focused on assessing 3–4 indicators and do not reflect all walking parameters. The development of new methods for assessing the effectiveness of treatment of walking and balance disorders in patients with gait disorder is a highly relevant problem.

Aim. To analyze the developed method for assessing the effectiveness of treatment of walking and balance disorders in patients with gait disorders in clinical practice using the example of lSCS.

Material and methods. To assess the walking method, 15 gait parameters are proposed, which are compared before treatment and at least once during or after treatment. As an example of using the developed scale, patients with central gait disorder who underwent trail lSCS were taken. The assessment results according to the above scale were compared with the EDSS, MSWS-12, 25-foot walk time and 6-minute walk distance

Results. 26 patients were tested, positive dynamics according to the scale we proposed was noted in 19 of them. The EDSS scale did not reflect changes in walking within the rank, the 25-foot walking time did not identify patients with an increase in distance without changing the walking time, a 6-minute walk did not allow testing patients with a minimum walkable distance, the MSWS-12 scale revealed greater positive dynamics and assessed walking based on the subjective sensations of the patient. The use of the scale we proposed allowed us to identify patients for implantation of a permanent lSCS system, which was effective in 9 out of 13 observations.

Conclusion. The developed scale allows for a quick and objective assessment of the effectiveness of the treatment method used for gait disorders by many parameters. It allows for the assessment of both simple walking parameters (distance, walking time over a given distance) and complex options (interval walking with turns, walking up stairs, running), as well as balance disorders that arise with gait disorders.

Design: retrospective study.

Keywords: neurostimulation; electrical stimulation of the spinal cord; spasticity; gait disturbance; gait disorders; gait disturbance scale

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