Effect of bilateral subthalamic nucleus stimulation on parkinsonian gait

Xie, Jing; Krack, Paul; Benabid, Alim‐Louis; Pollak, Pierre

doi:10.1007/s004150170027

Cited by 49 publications

(39 citation statements)

References 31 publications

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“…Although basal ganglia cannot initiate movements, they play a monitoring role in automatic movement sequences by matching performance outcomes with original plans [38]. It is known that the premotor cortex sets motor plans, such as stride length, and that the basal ganglia provide the SMA with the correct motor set and appropriate way-timed phase cues to enable the motor plan to run to completion [5,39,40].…”

Section: Discussionmentioning

confidence: 99%

Does gait analysis quantify motor rehabilitation efficacy in Parkinson's disease patients?

Peppe¹,

Chiavalon²,

Pasqualetti³

et al. 2007

Gait & Posture

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Section: Discussionmentioning

confidence: 99%

Does gait analysis quantify motor rehabilitation efficacy in Parkinson's disease patients?

Peppe¹,

Chiavalon²,

Pasqualetti³

et al. 2007

Gait & Posture

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“…Thus, L-dopa and STN stimulation equally improve stride length and velocity. 36,37 In addition, in most studies, cadence remained unchanged whatever the treatment, 38,39 although in some instances it was better improved by STN stimulation than by L-dopa. 34 In contrast, other studies suggest a lesser efficacy of STN stimulation relative to L-dopa.…”

Section: Comparison Of Levodopa and Stn Stimulation Effects On Gaitmentioning

confidence: 94%

Deep brain stimulation effect on freezing of gait

2008

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The majority of patients with Parkinson's disease suffer from freezing of gait (FOG), which responds more or less to levodopa. Thalamic stimulation, mainly used in the treatment of tremor dominant Parkinson's disease is ineffective in FOG. GPi stimulation moderately improves FOG, but this effect may abate in the long term. STN stimulation was reported to improve levodopa-responsive FOG. In some patients, the benefit from levodopa is greater than that from STN stimulation, and levodopa and STN stimulation can have additive effects. On the contrary, STN stimulation is ineffective on levodopa-resistant FOG. In the few cases of levodopa-induced FOG, STN stimulation can indirectly be effective, thanks to a great decrease or arrest of levodopa. Stimulation of the pedunculopontine nucleus has recently been performed in small groups of patients suffering from both off- and on-levodopa gait impairments. The first results appear encouraging, but they need to be confirmed by controlled studies in larger series of patients.

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“…Chronic side effects of subthalamic DBS on speech and gait: use of low frequency While STN stimulation has been associated with improvement of stride length and in gait velocity as well as increased amplitude of arm and leg swing movements [67,68], over time many STN-stimulated patients complain about gait and balance deterioration and there may be an increased risk of falls and worsening of levodopa-resistant FOG [69,70]. Speech may also be significantly worsened with STN DBS, directly correlated with amplitude and duration of stimulation, along with abnormal laryngeal muscle contraction [71][72][73].…”

Section: Dbs Programmingmentioning

confidence: 99%

Deep brain stimulation for movement disorders: update on recent discoveries and outlook on future developments

2015

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Modern deep brain stimulation (DBS) has become a routine therapy for patients with movement disorders such as Parkinson's disease, generalized or segmental dystonia and for multiple forms of tremor. Growing numbers of publications also report beneficial effects in other movement disorders such as Tourette's syndrome, various forms of chorea and DBS is even being studied for Parkinson's-related dementia. While exerting remarkable effects on many motor symptoms, DBS does not restore normal neurophysiology and therefore may also have undesirable side effects including speech and gait deterioration. Furthermore, its efficacy might be compromised in the long term, due to progression of the underlying disease. Various programming strategies have been studied to try and address these issues, e.g., the use of low-frequency rather than high-frequency stimulation or the targeting of alternative brain structures such as the pedunculopontine nucleus. In addition, further technical developments will soon provide clinicians with an expanded choice of hardware such as segmented electrodes allowing for a steering of the current to optimize beneficial effects and reduce side effects as well as the possibility of adaptive stimulation systems based on closed-loop concepts with or without accompanying advances in programming and imaging software. In the present article, we will provide an update on the most recent achievements and discoveries relevant to the application of DBS in the treatment of movement disorder patients and give an outlook on future clinical and technical developments.

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Effect of bilateral subthalamic nucleus stimulation on parkinsonian gait

Cited by 49 publications

References 31 publications

Does gait analysis quantify motor rehabilitation efficacy in Parkinson's disease patients?

Does gait analysis quantify motor rehabilitation efficacy in Parkinson's disease patients?

Deep brain stimulation effect on freezing of gait

Deep brain stimulation for movement disorders: update on recent discoveries and outlook on future developments

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