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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References
- Segmentation and classification of gait cycles.IEEE Trans. Neural Syst. Rehabil. Eng. 2014; 22: 946-952https://doi.org/10.1109/TNSRE.2013.2291907
- Gait parameters and muscle activation patterns at 3, 6 and 12 months after total hip arthroplasty.J. Arthroplast. 2014; 29: 1265-1272https://doi.org/10.1016/j.arth.2013.12.018
- Instrumented gait analysis for an objective pre−/postassessment of tap test in normal pressure hydrocephalus.Arch. Phys. Med. Rehabil. 2015; 96: 1235-1241https://doi.org/10.1016/j.apmr.2015.02.014
- Multiple gait patterns within the same winters class in children with hemiplegic cerebral palsy.Clin Biomech (Bristol, Avon). 2015; 30: 908-914https://doi.org/10.1016/j.clinbiomech.2015.07.010
- Deep brain stimulation for Parkinson’s disease.Mov. Disord. 2006; 21: S168-S170https://doi.org/10.1002/mds.20954
- Deep brain stimulation of the subthalamic nucleus for the treatment of Parkinson’s disease.Lancet Neurol. 2009; 8: 67-81https://doi.org/10.1016/S1474-4422(08)70291-6
- Self-reported gait unsteadiness in mildly impaired neurological patients: an objective assessment through statistical gait analysis.J Neuroeng Rehabil. 2012; 9: 64https://doi.org/10.1186/1743-0003-9-64
- Falls and freezing of gait in Parkinson’s disease: a review of two interconnected, episodic phenomena.Mov. Disord. 2004; 19: 871-884https://doi.org/10.1002/mds.20115
- Comparative analysis of gait and speech in Parkinson’s disease: hypokinetic or dysrhythmic disorders?.J. Neurol. Neurosurg. Psychiatry. 2010; 81: 177-184https://doi.org/10.1136/jnnp.2009.174375
- Axial disability and deep brain stimulation in patients with Parkinson disease.Nat. Rev. Neurol. 2015; 11: 98-110https://doi.org/10.1038/nrneurol.2014.252
- Effects of bilateral subthalamic stimulation on gait kinematics and kinetics in Parkinson’s disease.Exp. Brain Res. 2005; 160: 517-527https://doi.org/10.1007/s00221-004-2036-5
- Deep brain stimulation for essential tremor: a systematic review.Mov. Disord. 2010; 25: 1550-1559https://doi.org/10.1002/mds.23195
- Medical treatment of freezing of gait.Mov. Disord. 2008; 23: S482-S488https://doi.org/10.1002/mds.21914
- Freezing of gait in patients with advanced Parkinson’s disease.J. Neural Transm. 2001; 108: 53-61
- Multicenter study on deep brain stimulation in Parkinson’s disease: an independent assessment of reported adverse events at 4 years.Mov. Disord. 2008; 23: 416-421https://doi.org/10.1002/mds.21888
- Gait variability and basal ganglia disorders: stride-to-stride variations of gait cycle timing in Parkinson’s disease and Huntington’s disease.Mov. Disord. 1998; 13: 428-437https://doi.org/10.1002/mds.870130310
- Deep brain stimulation effects on gait variability in Parkinson’s disease.Mov. Disord. 2009; 24: 1688-1692https://doi.org/10.1002/mds.22554
- Improved asymmetry of gait in Parkinson’s disease with DBS: gait and postural instability in Parkinson’s disease treated with bilateral deep brain stimulation in the subthalamic nucleus.Mov. Disord. 2009; 24: 590-597https://doi.org/10.1002/mds.22419
- Reliability and validity of the Tinetti mobility test for individuals with Parkinson disease.Phys. Ther. 2007; 87: 1369-1378https://doi.org/10.2522/ptj.20070007
- Assessing the effects of subthalamic nucleus stimulation on gait and mobility in people with Parkinson disease.Disabil. Rehabil. 2010; 32: 929-936https://doi.org/10.3109/09638280903374139
- Motion biomarkers showing maximum contrast between healthy subjects and Parkinson’s disease patients treated with deep brain stimulation of the subthalamic nucleus. A Pilot Study.Front Neurosci. 2019; 13: 1450https://doi.org/10.3389/fnins.2019.01450
- Gait analysis in patients with advanced Parkinson disease: different or additive effects on gait induced by levodopa and chronic STN stimulation.J. Neural Transm. (Vienna). 2006; 113: 163-173https://doi.org/10.1007/s00702-005-0310-8
- A clinical view on the development of technology-based tools in managing Parkinson’s disease.Mov. Disord. 2016; 31: 1263-1271https://doi.org/10.1002/mds.26673
- Deep brain stimulation in the globus pallidus to treat dystonia: electrophysiological characteristics and 2 years’ follow-up in 10 patients.Neuroscience. 2008; 152: 558-571https://doi.org/10.1016/j.neuroscience.2008.01.001
- Medication and subthalamic nucleus deep brain stimulation similarly improve balance and complex gait in Parkinson disease.Parkinsonism Relat. Disord. 2013; 19: 86-91https://doi.org/10.1016/j.parkreldis.2012.07.013
- Effects of deep brain stimulation of dorsal versus ventral subthalamic nucleus regions on gait and balance in Parkinson’s disease.J. Neurol. Neurosurg. Psychiatry. 2011; 82: 1250-1255https://doi.org/10.1136/jnnp.2010.232900
- Quantitative analysis of gait and balance response to deep brain stimulation in Parkinson’s disease.Gait Posture. 2013; 38: 109-114https://doi.org/10.1016/j.gaitpost.2012.10.025
- Abnormalities in the stride length-cadence relation in parkinsonian gait.Mov. Disord. 1998; 13: 61-69https://doi.org/10.1002/mds.870130115
- Reliability of measurements obtained with the timed “up & go” test in people with Parkinson disease.Phys. Ther. 2001; 81: 810-818https://doi.org/10.1093/ptj/81.2.810
- Deep-brain stimulation in the subthalamic nuclei improves balance performance in patients with Parkinson’s disease, when tested without anti-parkinsonian medication.Acta Neurol. Scand. 2005; 111: 301-308https://doi.org/10.1111/j.1600-0404.2005.00394.x
- The effects of high frequency subthalamic stimulation on balance performance and fear of falling in patients with Parkinson’s disease.J Neuroeng Rehabil. 2009; 6: 13https://doi.org/10.1186/1743-0003-6-13
- The timed “up & go”: a test of basic functional mobility for frail elderly persons.J. Am. Geriatr. Soc. 1991; 39: 142-148
- Deep brain stimulation improves gait velocity in Parkinson’s disease: a systematic review and meta-analysis.J. Neurol. 2016; 263: 1195-1203https://doi.org/10.1007/s00415-016-8129-9
- Gait dynamics in Parkinson’s disease: relationship to Parkinsonian features, falls and response to levodopa.J. Neurol. Sci. 2003; 212: 47-53
- Short pulse and conventional deep brain stimulation equally improve the Parkinsonian gait disorder.J. Parkinsons Dis. 2021; https://doi.org/10.3233/JPD-202492
- Quantitative assessments of gait and mobility in Parkinson’s disease.J. Neural Transm. Suppl. 1983; 19: 201-214
- Performance-oriented assessment of mobility problems in elderly patients.J. Am. Geriatr. Soc. 1986; 34: 119-126https://doi.org/10.1111/j.1532-5415.1986.tb05480.x
- Fall risk index for elderly patients based on number of chronic disabilities.Am. J. Med. 1986; 80: 429-434
- Low-frequency versus high-frequency subthalamic nucleus deep brain stimulation on postural control and gait in Parkinson’s disease: a quantitative study.Brain Stimul. 2015; 8: 64-75https://doi.org/10.1016/j.brs.2014.10.011
- Quantitative gait analysis in patients with advanced Parkinson’s disease.Rev. Neurol. 2016; 63: 97-102
- Subthalamic nucleus stimulation and levodopa-resistant postural instability in Parkinson’s disease.J. Neurol. 2008; 255: 205-210https://doi.org/10.1007/s00415-008-0636-x
- Nigral stimulation for resistant axial motor impairment in Parkinson’s disease? A randomized controlled trial.Brain. 2013; 136: 2098-2108https://doi.org/10.1093/brain/awt122
- Can quantitative gait analysis be used to guide treatment of patients with different subtypes of Parkinson’s disease?.Neuropsychiatr. Dis. Treat. 2020; 16: 2335-2341https://doi.org/10.2147/NDT.S266585
- Effect of bilateral subthalamic nucleus stimulation on parkinsonian gait.J. Neurol. 2001; 248: 1068-1072
- Effects of pedunculopontine nucleus deep brain stimulation on gait disorders in Parkinson’s disease: a meta-analysis of the literature.Clin. Neurol. Neurosurg. 2020; 198106108https://doi.org/10.1016/j.clineuro.2020.106108
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.