Evolution of postural stability after subthalamic nucleus stimulation in Parkinson's disease:: a combined clinical and posturometric study
Evolution of postural stability after subthalamic nucleus stimulation in Parkinson's disease:: a combined clinical and posturometric study
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DOI：
10.1007/s00221-005-0202-z
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发表时间：
2006-04-01
影响因子：
2
通讯作者：
Burbaud, P
中科院分区：
文献类型：
--
作者：
Guehl, D;Dehail, P;Burbaud, P
目的：姿势和平衡障碍的发生是帕金森病（PD）晚期的常见特征。然而，这些障碍的病理基质知之甚少。研究方法：在目前的工作中，我们研究了7名接受丘脑底核（DBS）双侧脑深部电刺激（DBS）的PD患者术前和术后3个月之间的姿势测量参数[压力中心（CoP）位移和CoP面积]和轴向评分的演变。结果如下：手术后，患者向后倾斜得更多，而不管是否有电刺激，这表明手术可能对姿势适应产生有害影响。在术后期间，左旋多巴治疗和DBS治疗的轴向和姿势评分改善相似。另一方面，DBS的小脑延髓背侧部显着减少CoP位移和CoP面积，而左旋多巴治疗往往只减少CoP位移和增加CoP面积显着。结论：这些数据表明，DBS和左旋多巴不作用于相同的神经系统参与姿势调节。DBS可以通过直接作用于脚桥核来改善姿势，脚桥核已知参与姿势调节。
Objectives: The occurrence of postural and balance disorders is a frequent feature in advanced forms of Parkinson's disease (PD). However, the pathological substrate of these disturbances is poorly understood. Methods: In the present work, we investigated the evolution of posturometric parameters [center of pressure (CoP) displacement and CoP area] and axial scores between the pre-operative period and 3 months post-operative in seven PD patients who underwent bilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN). Results: After surgery, the patients leaned backwards much more regardless of the STN stimulation, suggesting that surgery could have a deleterious effect on postural adaptation. During the post-operative period, the improvement in axial and postural scores was similar under levodopatherapy and DBS. On the other hand, DBS of the STN significantly reduced the CoP displacement and the CoP area, whereas levodopatherapy tended only to reduce the CoP displacement and to increase the CoP area significantly. Conclusions: These data suggest that DBS of the STN and levodopa do not act on the same neurological systems involved in posture regulation. DBS of the STN could improve posture via a direct effect on the pedunculopontine nucleus, which is known to be involved in posture regulation.