Highlights
- •Advanced Parkinson's disease is associated with gait alterations and postural instability.
- •Effects of subthalamic nucleus deep brain stimulation on gait and balance remain a matter of debate.
- •We have analysed gait of Parkinson's disease patients with stimulation of the subthalamic nucleus.
- •Subthalamic nucleus deep brain stimulation improved gait and balance in these patients.
- •Our results highlight the major role of the subthalamic nucleus in motor control mechanisms.
Abstract
Background
Advanced stages of idiopathic Parkinson's disease are often characterised by gait
alterations and postural instability. Despite improvements in patients' motor symptoms
after deep brain stimulation of the subthalamic nucleus, its effects on gait and balance
remain a matter of debate. This study investigated the effects of deep brain stimulation
on balance and kinematic parameters of gait.
Methods
The gait of 26 patients with advanced idiopathic Parkinson's disease was analysed
before and after (between 3 and 6 months) after bilateral deep brain stimulation of
the subthalamic nucleus. Computerised analysis was used to study cadence, number of
cycles with the correct support sequence, number of cycles, duration of the cycle
stages, and knee and ankle goniometry. Balance, postural instability, and mobility
were assessed using the Tinetti and Timed Up and Go test.
Findings
After stimulation, the following changes were significant (p < 0.01): number of cycles with the correct support sequence, number of total cycles,
and foot contact. Patients improved significantly (p < 0.01) in the Tinetti and Timed Up and Go tests, the risk factors for falls changed
from high (median 17) to low (median 25), and they improved from minor dependence
(statistical median 14) to normality (statistical median 8.70).
Interpretation
Deep brain stimulation to inhibit hyperactivity of the subthalamic nucleus was associated
with an improvement in the space-time variables of gait and balance in patients with
Parkinson's disease for up to 3–6 months. These results highlight the major role of
the subthalamic nucleus in motor control mechanisms during locomotion and balance.
Keywords
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Article info
Publication history
Published online: August 11, 2022
Accepted:
August 9,
2022
Received:
February 28,
2022
Identification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
