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Palmisano C, Farinelli V, Camuncoli F, Favata A, Pezzoli G, Frigo CA, Isaias IU. Dynamic evaluation of spine kinematics in individuals with Parkinson's disease and freezing of gait. Gait Posture 2024; 108:199-207. [PMID: 37993298 DOI: 10.1016/j.gaitpost.2023.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 10/23/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND Freezing of gait (FoG) is an episodic failure of gait exposing people with Parkinson's disease (PD) to a high risk of falling. Despite growing evidence of the interconnection between impaired trunk control and FoG, a detailed description of spinal kinematics during walking is still lacking in this population. RESEARCH QUESTION Do spinal alterations impact gait performance in individuals with PD and FoG? METHODS We analyzed kinematic data of 47 PD participants suffering (PD-FOG, N = 24) or not suffering from FoG (PD-NFOG, N = 23) and 15 healthy controls (HCO) during quiet standing and unperturbed walking. We estimated the main spinal variables (i.e., spinal length, lordosis and kyphosis angles, trunk inclination), the pelvis angles, and the shoulder-pelvis angles during gait and standing. We studied differences across conditions and groups and the relationships between postural and gait parameters using linear regression methods. RESULTS During standing and walking, both PD groups showed increased trunk inclination and decreased lordosis angle with respect to HCO, as well as a decreased range in variation of kyphosis angle, pelvic obliquity, and shoulder-pelvis angles. Only PD-FOG participants showed reduced range of lordosis angle and spinal length compared to HCO. PD-FOG individuals were also not able to straighten their spine during walking compared to standing. Stride length and velocity were decreased in both patient groups compared to HCO, while swing duration was reduced only in the PD-FOG group. In individuals with FoG, trunk inclination and lordosis angle showed moderate but significant positive correlations with all gait alterations. SIGNIFICANCE Spine alterations impacted gait performance in individuals with PD suffering from FoG. Excessive trunk inclination and poor mastering of the lordosis spinal region may create an unfavourable postural precondition for forward walking. Physical therapy should target combined spinal and stepping alterations in these individuals.
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Affiliation(s)
- C Palmisano
- Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Würzburg, Germany.
| | - V Farinelli
- Human Physiology Section of the DePT, Università degli Studi di Milano, Milano, Italy
| | - F Camuncoli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - A Favata
- Biomechanical Engineering Lab, Department of Mechanical Engineering and Research Centre for Biomedical Engineering, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - G Pezzoli
- Parkinson Institute Milan, ASST G. Pini-CTO, Milano, Italy
| | - C A Frigo
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - I U Isaias
- Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Würzburg, Germany; Parkinson Institute Milan, ASST G. Pini-CTO, Milano, Italy
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Heß T, Themann P, Oehlwein C, Milani TL. Does Impaired Plantar Cutaneous Vibration Perception Contribute to Axial Motor Symptoms in Parkinson's Disease? Effects of Medication and Subthalamic Nucleus Deep Brain Stimulation. Brain Sci 2023; 13:1681. [PMID: 38137129 PMCID: PMC10742284 DOI: 10.3390/brainsci13121681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 11/28/2023] [Accepted: 12/03/2023] [Indexed: 12/24/2023] Open
Abstract
OBJECTIVE To investigate whether impaired plantar cutaneous vibration perception contributes to axial motor symptoms in Parkinson's disease (PD) and whether anti-parkinsonian medication and subthalamic nucleus deep brain stimulation (STN-DBS) show different effects. METHODS Three groups were evaluated: PD patients in the medication "on" state (PD-MED), PD patients in the medication "on" state and additionally "on" STN-DBS (PD-MED-DBS), as well as healthy subjects (HS) as reference. Motor performance was analyzed using a pressure distribution platform. Plantar cutaneous vibration perception thresholds (VPT) were investigated using a customized vibration exciter at 30 Hz. RESULTS Motor performance of PD-MED and PD-MED-DBS was characterized by greater postural sway, smaller limits of stability ranges, and slower gait due to shorter strides, fewer steps per minute, and broader stride widths compared to HS. Comparing patient groups, PD-MED-DBS showed better overall motor performance than PD-MED, particularly for the functional limits of stability and gait. VPTs were significantly higher for PD-MED compared to those of HS, which suggests impaired plantar cutaneous vibration perception in PD. However, PD-MED-DBS showed less impaired cutaneous vibration perception than PD-MED. CONCLUSIONS PD patients suffer from poor motor performance compared to healthy subjects. Anti-parkinsonian medication in tandem with STN-DBS seems to be superior for normalizing axial motor symptoms compared to medication alone. Plantar cutaneous vibration perception is impaired in PD patients, whereas anti-parkinsonian medication together with STN-DBS is superior for normalizing tactile cutaneous perception compared to medication alone. Consequently, based on our results and the findings of the literature, impaired plantar cutaneous vibration perception might contribute to axial motor symptoms in PD.
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Affiliation(s)
- Tobias Heß
- Department of Human Locomotion, Chemnitz University of Technology, 09126 Chemnitz, Germany
| | - Peter Themann
- Department of Neurology and Parkinson, Clinic at Tharandter Forest, 09633 Halsbruecke, Germany
| | - Christian Oehlwein
- Neurological Outpatient Clinic for Parkinson Disease and Deep Brain Stimulation, 07551 Gera, Germany
| | - Thomas L. Milani
- Department of Human Locomotion, Chemnitz University of Technology, 09126 Chemnitz, Germany
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Ramdhani RA, Watts J, Kline M, Fitzpatrick T, Niethammer M, Khojandi A. Differential spatiotemporal gait effects with frequency and dopaminergic modulation in STN-DBS. Front Aging Neurosci 2023; 15:1206533. [PMID: 37842127 PMCID: PMC10570440 DOI: 10.3389/fnagi.2023.1206533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 09/01/2023] [Indexed: 10/17/2023] Open
Abstract
Objective The spatiotemporal gait changes in advanced Parkinson's disease (PD) remain a treatment challenge and have variable responses to L-dopa and subthalamic deep brain stimulation (STN-DBS). The purpose of this study was to determine whether low-frequency STN-DBS (LFS; 60 Hz) elicits a differential response to high-frequency STN-DBS (HFS; 180 Hz) in spatiotemporal gait kinematics. Methods Advanced PD subjects with chronic STN-DBS were evaluated in both the OFF and ON medication states with LFS and HFS stimulation. Randomization of electrode contact pairs and frequency conditions was conducted. Instrumented Stand and Walk assessments were carried out for every stimulation/medication condition. LM-ANOVA was employed for analysis. Results Twenty-two PD subjects participated in the study, with a mean age (SD) of 63.9 years. Significant interactions between frequency (both LFS and HFS) and electrode contact pairs (particularly ventrally located contacts) were observed for both spatial (foot elevation, toe-off angle, stride length) and temporal (foot speed, stance, single limb support (SLS) and foot swing) gait parameters. A synergistic effect was also demonstrated with L-dopa and both HFS and LFS for right SLS, left stance, left foot swing, right toe-off angle, and left arm range of motion. HFS produced significant improvement in trunk and lumbar range of motion compared to LFS. Conclusion The study provides evidence of synergism of L-dopa and STN-DBS on lower limb spatial and temporal measures in advanced PD. HFS and LFS STN-DBS produced equivalent effects among all other tested lower limb gait features. HFS produced significant trunk and lumbar kinematic improvements.
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Affiliation(s)
- Ritesh A. Ramdhani
- Department of Neurology, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - Jeremy Watts
- Department of Industrial and Systems Engineering, University of Tennessee, Knoxville, TN, United States
| | - Myriam Kline
- Center for Neurosciences, Feinstein Institutes for Medical Research at Northwell Health, Manhasset, NY, United States
| | - Toni Fitzpatrick
- Center for Neurosciences, Feinstein Institutes for Medical Research at Northwell Health, Manhasset, NY, United States
| | - Martin Niethammer
- Department of Neurology, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Center for Neurosciences, Feinstein Institutes for Medical Research at Northwell Health, Manhasset, NY, United States
| | - Anahita Khojandi
- Department of Industrial and Systems Engineering, University of Tennessee, Knoxville, TN, United States
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Senevirathne DKL, Mahboob A, Zhai K, Paul P, Kammen A, Lee DJ, Yousef MS, Chaari A. Deep Brain Stimulation beyond the Clinic: Navigating the Future of Parkinson's and Alzheimer's Disease Therapy. Cells 2023; 12:1478. [PMID: 37296599 PMCID: PMC10252401 DOI: 10.3390/cells12111478] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 04/30/2023] [Accepted: 05/16/2023] [Indexed: 06/12/2023] Open
Abstract
Deep brain stimulation (DBS) is a surgical procedure that uses electrical neuromodulation to target specific regions of the brain, showing potential in the treatment of neurodegenerative disorders such as Parkinson's disease (PD) and Alzheimer's disease (AD). Despite similarities in disease pathology, DBS is currently only approved for use in PD patients, with limited literature on its effectiveness in AD. While DBS has shown promise in ameliorating brain circuits in PD, further research is needed to determine the optimal parameters for DBS and address any potential side effects. This review emphasizes the need for foundational and clinical research on DBS in different brain regions to treat AD and recommends the development of a classification system for adverse effects. Furthermore, this review suggests the use of either a low-frequency system (LFS) or high-frequency system (HFS) depending on the specific symptoms of the patient for both PD and AD.
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Affiliation(s)
| | - Anns Mahboob
- Weill Cornell Medicine-Qatar, Education City, Qatar Foundation, Doha 24144, Qatar
| | - Kevin Zhai
- Weill Cornell Medicine-Qatar, Education City, Qatar Foundation, Doha 24144, Qatar
| | - Pradipta Paul
- Weill Cornell Medicine-Qatar, Education City, Qatar Foundation, Doha 24144, Qatar
| | - Alexandra Kammen
- Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Darrin Jason Lee
- Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
- USC Neurorestoration Center, University of Southern California, Los Angeles, CA 90033, USA
| | - Mohammad S. Yousef
- Weill Cornell Medicine-Qatar, Education City, Qatar Foundation, Doha 24144, Qatar
| | - Ali Chaari
- Weill Cornell Medicine-Qatar, Education City, Qatar Foundation, Doha 24144, Qatar
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Effects of deep brain stimulation on balance and gait in patients with Parkinson's disease: A systematic neurophysiological review. Neurophysiol Clin 2015; 45:371-88. [DOI: 10.1016/j.neucli.2015.07.001] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Revised: 06/23/2015] [Accepted: 07/16/2015] [Indexed: 12/17/2022] Open
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Pötter-Nerger M, Volkmann J. Deep brain stimulation for gait and postural symptoms in Parkinson's disease. Mov Disord 2014; 28:1609-15. [PMID: 24132849 DOI: 10.1002/mds.25677] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 08/16/2013] [Indexed: 11/06/2022] Open
Abstract
In patients with Parkinson's disease, gait and balance difficulties have emerged as some of the main therapeutic concerns. During earlier stages of the disease, the dopamine-responsive aspects of gait disorder can be treated initially with dopaminergic drugs or deep brain stimulation. However, certain temporal aspects of parkinsonian gait disorder remain therapeutically resistant in both the short term and the long term. In this review, we summarize the effects of deep brain stimulation on gait and postural symptoms in the five currently available targets (subthalamic nucleus, globus pallidus, ventralis intermedius thalamic nucleus, pedunculopontine nucleus, and substantia nigra) and describe programming strategies for patients who are mainly disabled by gait problems.
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Validation of GDI, GPS and GVS for use in Parkinson's disease through evaluation of effects of subthalamic deep brain stimulation and levodopa. Gait Posture 2014; 39:1142-5. [PMID: 24548797 DOI: 10.1016/j.gaitpost.2014.01.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 01/15/2014] [Accepted: 01/20/2014] [Indexed: 02/02/2023]
Abstract
The Gait Deviation Index (GDI), Gait Profile Score (GPS) and Gait Variable Scores (GVSs) have been proposed as measures of gait quality and validated for use with children with cerebral palsy. The aim of this study was to extend this validation to people with Parkinson's disease by evaluating the effects of subthalamic deep brain stimulation and levodopa on gait. 16 participants had their gait evaluated with stimulation, medication or a combination of both. The Unified Parkinson's Disease Rating Scale (UPDRS) showed statistically significant differences in agreement with previous studies. The GPS and GDI showed similar treatment effects as did GVS for hip and knee flexion/extension, as assessed with Cohen's d where medium or large. Overall the results suggest that these gait indices are sensitive to treatment in this group of patients and that their use in groups other than children with cerebral palsy is valid.
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Takayanagi N, Beppu H, Mizutani K, Tomita Y, Nagao S, Suzuki S, Orand A, Takahashi H, Sonoda S. Pelvic axis-based gait analysis for ataxic mice. J Neurosci Methods 2013; 219:162-8. [PMID: 23912024 DOI: 10.1016/j.jneumeth.2013.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 07/11/2013] [Accepted: 07/22/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Although different gait analysis methods such as Walking Track Analysis exist, they cannot be used to demonstrate the physical condition of mice with specific gait disorder characteristic. Therefore, we developed a new method for the gait analysis of such mice to accurately assess hind limb angle based on the pelvic axis. NEW METHOD We established and verified a gait analysis method capable of pelvic axis-based limb angle measurement by video-recording the gait of a control mice group (C57BL/6J(B6)) and three ataxic mice (ataxic B6-wob/t, Parkinson's disease model (1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine treated (MPTP)), and cerebellum hypoplasia (cytosine-β-d-arabinofuranoside treated)) from the ventral side. RESULTS The assessed hind limb angles of B6-wob/t and MPTP-treated mice were significantly wider than B6 mice (p<0.01). Moreover, we could draw separating lines with slopes of minus one that could separate the data of each group in the scatter plot of the normalized hind limb step width and angle. COMPARISON WITH EXISTING METHODS We found no significance when we applied the already existing nose-tail method for the analysis of the hind limb angles of B6 and B6-wob/t mice. In the nose-tail method, since the whole body axis of the trunk varies while the trunk of the mouse is laterally bent changing the hind limb angle, B6 and B6-wob/t mice could not be differentiated. However, the two mice groups could be differentiated by the pelvic axis-based gait analysis method. CONCLUSION The pelvic axis-based gait analysis method is promising and valid for mice with gait disorder.
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Affiliation(s)
- Naoki Takayanagi
- Rehabilitation Medicine II, Graduate School of Medicine, Fujita Health University, Mie 514-1296, Japan.
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Waldau B, Clayton DA, Gasperson LB, Turner DA. Analysis of the time course of the effect of subthalamic nucleus stimulation upon hand function in Parkinson's patients. Stereotact Funct Neurosurg 2011; 89:48-55. [PMID: 21252589 DOI: 10.1159/000323340] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2010] [Accepted: 12/02/2010] [Indexed: 11/19/2022]
Abstract
BACKGROUND Deep brain stimulation (DBS) of the subthalamic nucleus (STN) as treatment for Parkinson's disease has been in use for more than a decade, yet the immediate effect of stimulation upon movement parameters is not well characterized. OBJECTIVE The goal of the current study is the identification of the best time point to test hand function after programming DBS devices. METHODS Reaction time, movement time and velocity were measured at multiple time points with a movement-sensitive glove after the deep brain stimulator had been turned on or off, during 'off medication' conditions. RESULTS Velocity, movement time and reaction time worsened significantly in the first 20 min after the deep brain stimulator had been turned off. A 'plateau effect' after 20 min was not observed. Initiation of stimulation led to immediate significant increases in movement time and velocity and to a lesser degree a decrease in reaction time. Patients performed more inconsistently over time after onset of stimulation compared to stimulation withdrawal. Intraoperative testing showed an immediate improvement in velocity after placement of the STN deep brain stimulator. CONCLUSION Movement time and velocity already reach their peak changes within 20 min after the deep brain stimulator has been reprogrammed, and therefore, this time point may be used to test the maximal clinical effect of stimulation.
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Affiliation(s)
- Ben Waldau
- Department of Surgery, Division of Neurosurgery, Duke University Medical Center, Durham, NC 27710, USA.
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Kovacic P, Somanathan R. Electromagnetic fields: mechanism, cell signaling, other bioprocesses, toxicity, radicals, antioxidants and beneficial effects. J Recept Signal Transduct Res 2010; 30:214-26. [DOI: 10.3109/10799893.2010.488650] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Gubellini P, Salin P, Kerkerian-Le Goff L, Baunez C. Deep brain stimulation in neurological diseases and experimental models: From molecule to complex behavior. Prog Neurobiol 2009; 89:79-123. [DOI: 10.1016/j.pneurobio.2009.06.003] [Citation(s) in RCA: 119] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2008] [Revised: 04/28/2009] [Accepted: 06/18/2009] [Indexed: 11/30/2022]
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Johnsen EL, Mogensen PH, Sunde NA, Østergaard K. 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; 24:590-7. [PMID: 19097189 DOI: 10.1002/mds.22419] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Postural instability is a sign of progression of Parkinson's disease (PD) and often resistant to levodopa treatment. To explore the effect of bilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN) on postural stability and gait, full body gait analyses were performed without medication, OFF and ON DBS in eight PD patients and 12 healthy age-matched controls. DBS setting was changed at least 3 hours before gait analysis. To describe asymmetry most and least affected sides (MAS and LAS) were rated with the Unified Parkinson's Disease Rating Scale, motor part and quantitative gait analysis with the Vicon 612 gait analysis system. Stride length and gait velocity but not cadence improved ON DBS. The distances between the heel markers and center of mass (COM) were asymmetric and reduced OFF DBS. STN DBS increased the distances significantly and reduced asymmetry. The improvement in heel to COM distance was larger on the MAS compared with the LAS. OFF DBS knee momentum asymmetry was inversed so that LAS was more impaired than MAS. ON DBS asymmetry improved. PD patients OFF DBS place the heel too close to COM. The most affected body side has the most impaired swing and the result is a smaller knee moment on the opposite and least affected body side and an asymmetric gait pattern with disturbed balance OFF STN DBS. The asymmetry OFF DBS improved ON DBS. We suggest that DBS facilitates symmetric gait and thereby improves balance during gait.
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Affiliation(s)
- Erik L Johnsen
- Department of Neurology, Aarhus University Hospital, 8000 Aarhus C, Denmark.
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A computational modelling approach to investigate different targets in deep brain stimulation for Parkinson’s disease. J Comput Neurosci 2008; 26:91-107. [DOI: 10.1007/s10827-008-0100-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2007] [Revised: 03/18/2008] [Accepted: 05/13/2008] [Indexed: 10/22/2022]
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Tabbal SD, Ushe M, Mink JW, Revilla FJ, Wernle AR, Hong M, Karimi M, Perlmutter JS. Unilateral subthalamic nucleus stimulation has a measurable ipsilateral effect on rigidity and bradykinesia in Parkinson disease. Exp Neurol 2008; 211:234-42. [PMID: 18329019 DOI: 10.1016/j.expneurol.2008.01.024] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2007] [Revised: 11/28/2007] [Accepted: 01/26/2008] [Indexed: 11/30/2022]
Abstract
BACKGROUND Bilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN) improves motor function in Parkinson disease (PD). However, little is known about the quantitative effects on motor behavior of unilateral STN DBS. METHODS In 52 PD subjects with STN DBS, we quantified in a double-blinded manner rigidity (n=42), bradykinesia (n=38), and gait speed (n=45). Subjects were tested in four DBS conditions: both on, left on, right on and both off. A force transducer was used to measure rigidity across the elbow, and gyroscopes were used to measure angular velocity of hand rotations for bradykinesia. About half of the subjects were rated using the Unified Parkinson Disease Rating Scale (part III) motor scores for arm rigidity and repetitive hand rotation simultaneously during the kinematic measurements. Subjects were timed walking 25 feet. RESULTS All subjects had significant improvement with bilateral STN DBS. Contralateral, ipsilateral and bilateral stimulation significantly reduced rigidity and bradykinesia. Bilateral stimulation improved rigidity more than unilateral stimulation of either side, but there was no significant difference between ipsilateral and contralateral stimulation. Although bilateral stimulation also increased hand rotation velocity more than unilateral stimulation of either side, contralateral stimulation increased hand rotation significantly more than ipsilateral stimulation. All stimulation conditions improved walking time but bilateral stimulation provided the greatest improvement. CONCLUSIONS Unilateral STN DBS decreased rigidity and bradykinesia contralaterally as well ipsilaterally. As expected, bilateral DBS improved gait more than unilateral DBS.
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Affiliation(s)
- Samer D Tabbal
- Department of Neurology, Washington University in St. Louis, 4525 Scott Avenue, St. Louis, MO 63130, USA
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Peppe A, Chiavalon C, Pasqualetti P, Crovato D, Caltagirone C. Does gait analysis quantify motor rehabilitation efficacy in Parkinson's disease patients? Gait Posture 2007; 26:452-62. [PMID: 17240143 DOI: 10.1016/j.gaitpost.2006.11.207] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2006] [Revised: 11/08/2006] [Accepted: 11/12/2006] [Indexed: 02/02/2023]
Abstract
SUBJECTS Sixteen rigid-akinetic idiopathic Parkinson's disease patients (PD) and 13 healthy control subjects (controls) were included in this study. METHODS Gait analysis was performed using an optoelectronic system. The experimental design involved double evaluation of PD patients (before and after motor rehabilitation program) and a single evaluation of controls. ANOVA was performed in both groups for each gait variable (kinetic and kinematic) and for clinical conditions. RESULTS Analysis of kinetic data highlighted a statistically significant difference for all gait variables studied between controls and PD patients either before, or in the same PD patients before and after the motor rehabilitation program. After the rehabilitation program, natural walking speed increased (p<.000). The stance percentage was significantly decreased in the single support (p<.000). After the rehabilitation program, the double support limb phase did not show a reduction in statistical significance. Kinematic data showed statistical differences between controls and PD patients in hip, knee and ankle joint angles, both before and after the motor rehabilitation program. CONCLUSION Our results confirm that gait analysis is a valid tool for evaluating changes in PD patients' ability to walk and for quantifying the improvements gained through a motor rehabilitation program.
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Affiliation(s)
- A Peppe
- IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Roma, Italy.
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Liu W, McIntire K, Kim SH, Zhang J, Dascalos S, Lyons KE, Pahwa R. Bilateral subthalamic stimulation improves gait initiation in patients with Parkinson's disease. Gait Posture 2006; 23:492-8. [PMID: 16098748 DOI: 10.1016/j.gaitpost.2005.06.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2004] [Revised: 04/19/2005] [Accepted: 06/12/2005] [Indexed: 02/02/2023]
Abstract
Impaired gait initiation is one of the typical sign of advanced Parkinson's disease (PD). This is the first study to examine quantitatively the effect of deep brain stimulation of the subthalamic nucleus on the performance of gait initiation for patients with advanced PD. A total of 11 patients after surgery of bilateral deep brain stimulation of the subthalamic nucleus (STN) were tested in both the deep brain stimulation (DBS) ON and OFF conditions and/or in both the medication ON (i.e., with the usual dosage of antiparkinsonian medications administered) and OFF (i.e., with the usual dosage of antiparkinsonian medications withheld) conditions. DBS had no effect on the onset of anticipatory postural adjustment (APA). The effect of DBS approached significant level for the onset of swing foot lifting, but reached significant level for the delay of swing foot lifting. DBS significantly increased the amplitude of the APA, amplitude of reactive shear forces on both feet, and amplitude of COP in both anterior-posterior and medial-lateral directions. It is concluded that DBS significantly improved the performance of patients with advanced PD in gait initiation.
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Affiliation(s)
- W Liu
- Department of Physical Therapy & Rehabilitation Sciences, University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS 66160-7601, USA.
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Lang AE, Houeto JL, Krack P, Kubu C, Lyons KE, Moro E, Ondo W, Pahwa R, Poewe W, Tröster AI, Uitti R, Voon V. Deep brain stimulation: Preoperative issues. Mov Disord 2006; 21 Suppl 14:S171-96. [PMID: 16810718 DOI: 10.1002/mds.20955] [Citation(s) in RCA: 185] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Numerous factors need to be taken into account in deciding whether a patient with Parkinson's disease (PD) is a candidate for deep brain stimulation. Patient-related personal factors including age and the presence of other comorbid disorders need to be considered. Neuropsychological and neuropsychiatric concerns relate both to the presurgical status of the patient and to the potential for surgery to result in new problems postoperatively. A number of factors related to the underlying PD need to be considered, including the specific parkinsonian motor indications (e.g., tremor, bradykinesia, gait dysfunction), previous medical therapies, including benefit from current therapy and adverse effects, and past surgical treatments. Definable causes of Parkinsonism, particularly atypical Parkinsonisms, should be considered. Finally, methods of evaluating outcomes should be defined and formalized. This is a report from the Consensus on Deep Brain Stimulation for Parkinson's Disease, a project commissioned by the Congress of Neurological Surgeons and the Movement Disorder Society (MDS). The report has been endorsed by the Scientific Issues Committee of the MDS and the American Society of Stereotactic and Functional Neurosurgery. It outlines answers to a series of questions developed to address all aspects of deep brain stimulation preoperative decision-making.
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Affiliation(s)
- Anthony E Lang
- Department of Neurology, Toronto Western Hospital, Toronto, Ontario, Canada.
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Abstract
Deep brain stimulation (DBS) has provided remarkable benefits for people with a variety of neurologic conditions. Stimulation of the ventral intermediate nucleus of the thalamus can dramatically relieve tremor associated with essential tremor or Parkinson disease (PD). Similarly, stimulation of the subthalamic nucleus or the internal segment of the globus pallidus can substantially reduce bradykinesia, rigidity, tremor, and gait difficulties in people with PD. Multiple groups are attempting to extend this mode of treatment to other conditions. Yet, the precise mechanism of action of DBS remains uncertain. Such studies have importance that extends beyond clinical therapeutics. Investigations of the mechanisms of action of DBS have the potential to clarify fundamental issues such as the functional anatomy of selected brain circuits and the relationship between activity in those circuits and behavior. Although we review relevant clinical issues, we emphasize the importance of current and future investigations on these topics.
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Affiliation(s)
- Joel S. Perlmutter
- Departments of Neurology, Radiology, Physical Therapy and Anatomy & Neurobiology, Washington University School of Medicine, Washington University in St. Louis, St. Louis, Missouri 63110
| | - Jonathan W. Mink
- Departments of Neurology, Neurobiology & Anatomy, Brain & Cognitive Sciences, and Pediatrics, University of Rochester, Rochester, New York 14642
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Liu W, McIntire K, Kim SH, Zhang J, Dascalos S, Lyons KE, Pahwa R. Quantitative assessments of the effect of bilateral subthalamic stimulation on multiple aspects of sensorimotor function for patients with Parkinson's disease. Parkinsonism Relat Disord 2005; 11:503-8. [PMID: 16157502 DOI: 10.1016/j.parkreldis.2005.07.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2005] [Accepted: 07/06/2005] [Indexed: 10/25/2022]
Abstract
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is effective for the treatment of advanced Parkinson's disease. Most studies have evaluated the effectiveness of DBS of the STN using clinical motor scores or simple timed tests of motor function. There have been few studies that quantitatively assessed the outcome of STN DBS using multiple testing paradigms. In the current study, 11 patients who had bilateral STN DBS were quantitatively evaluated under four conditions using gait, postural control, and gait initiation. The four conditions included the medication on/stimulation on (M_on/S_on), medication on/stimulation off (M_on/S_off), medication off/stimulation on (M_off/S_on), and medication off/stimulation off (M_off/S_off) conditions. DBS of the STN significantly increased walking speed with and without levodopa, but had no influence on the cadence. The addition of levodopa had a minimal additional effect on walking speed. The effect of STN DBS on gait initiation approached the significant level. The mean values of lateral body sway during quiet standing increased moderately with medication and/or DBS, but the changes were not statistically significant. Future studies need to determine whether or not there is a potential negative effect of STN DBS on the postural control.
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Affiliation(s)
- W Liu
- Department of Physical Therapy and Rehabilitation Sciences, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160-7601, USA.
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Bakker M, Esselink RAJ, Munneke M, Limousin-Dowsey P, Speelman HD, Bloem BR. Effects of stereotactic neurosurgery on postural instability and gait in Parkinson's disease. Mov Disord 2004; 19:1092-9. [PMID: 15372604 DOI: 10.1002/mds.20116] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Postural instability and gait disability (PIGD) are disabling signs of Parkinson's disease. Stereotactic surgery aimed at the internal globus pallidus (GPi) or subthalamic nucleus (STN) might improve PIGD, but the precise effects remain unclear. We performed a systematic review of studies that examined the effects of GPi or STN surgery on PIGD. Most studies examined the effects of bilateral GPi stimulation, bilateral STN stimulation, and unilateral pallidotomy; we, therefore, only performed a meta-analysis on these studies. Bilateral GPi stimulation, bilateral STN stimulation, and to a lesser extent, unilateral pallidotomy significantly improved PIGD, and more so during the ON phase than during the OFF phase.
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Affiliation(s)
- Maaike Bakker
- Department of Neurology, University Medical Centre St Radboud, Nijmegen, The Netherlands
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