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
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
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DOI：
10.1002/mds.22419
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发表时间：
2009-03-15
影响因子：
8.6
通讯作者：
Ostergaard, Karen
中科院分区：
文献类型：
--
作者：
Johnsen, Erik L.;Mogensen, Poul H.;Ostergaard, Karen
姿势不稳定是帕金森病（PD）进展的标志，通常对左旋多巴治疗有抗性。为了探讨双侧丘脑底核深部脑刺激（DBS）对姿势稳定性和步态的影响，我们在不给药的情况下进行了全身步态分析。8名PD患者和12名年龄匹配的健康对照组的DBS。在步态分析前至少3小时改变DBS设置。为了描述不对称，用统一帕金森病评定量表对受影响最大和最小的侧（MAS和LAS）进行评定。使用Vicon 612步态分析系统进行定量步态分析。在DBS上，步幅和步态速度有所改善，但节奏没有改善。足跟标记与质心之间的距离不对称，减少了OFF DBS。STN DBS显著增加了距离，减少了不对称性。与LAS相比，MAS对足跟距的改善更大。OFF DBS膝关节动量不对称被逆转，因此LAS比MAS受损更严重。ON DBS不对称改善。PD患者OFF DBS时脚跟离足部太近。受影响最严重的身体一侧有最受损的摆动，结果是相反的膝盖力矩较小，受影响最小的身体一侧和不对称的步态模式，平衡受到干扰。OFF DBS的不对称性改善了ON DBS。我们建议DBS促进对称步态，从而改善步态平衡。(C) 2008运动障碍学会
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 balancc OFF STN DBS. The asymmetry OFF DBS inproved ON DBS. We suggest that DBS facilitates symmetric gait and thereby improves balance during gait. (C) 2008 Movement Disorder Society