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D'Ascanio I, Giannini G, Baldelli L, Cani I, Giannoni A, Leogrande G, Lopane G, Calandra-Buonaura G, Cortelli P, Chiari L, Palmerini L. A method for the synchronization of inertial sensor signals and local field potentials from deep brain stimulation systems. Biomed Phys Eng Express 2024; 10:057001. [PMID: 38959873 DOI: 10.1088/2057-1976/ad5e83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 07/03/2024] [Indexed: 07/05/2024]
Abstract
Objective. Recent innovative neurostimulators allow recording local field potentials (LFPs) while performing motor tasks monitored by wearable sensors. Inertial sensors can provide quantitative measures of motor impairment in people with subthalamic nucleus deep brain stimulation. To the best of our knowledge, there is no validated method to synchronize inertial sensors and neurostimulators without an additional device. This study aims to define a new synchronization method to analyze disease-related brain activity patterns during specific motor tasks and evaluate how LFPs are affected by stimulation and medication.Approach. Fourteen male subjects treated with subthalamic nucleus deep brain stimulation were recruited to perform motor tasks in four different medication and stimulation conditions. In each condition, a synchronization protocol was performed consisting of taps on the implanted neurostimulator, which produces artifacts in the LFPs that a nearby inertial sensor can simultaneously record.Main results. In 64% of the recruited subjects, induced artifacts were detected at least in one condition. Among those subjects, 83% of the recordings could be synchronized offline analyzing LFPs and wearables data. The remaining recordings were synchronized by video analysis.Significance. The proposed synchronization method does not require an external system (e.g., TENS electrodes) and can be easily integrated into clinical practice. The procedure is simple and can be carried out in a short time. A proper and simple synchronization will also be useful to analyze subthalamic neural activity in the presence of specific events (e.g., freezing of gait events) to identify predictive biomarkers.
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Affiliation(s)
- Ilaria D'Ascanio
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi" (DEI), University of Bologna, Bologna, Italy
| | - Giulia Giannini
- Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Luca Baldelli
- Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Ilaria Cani
- Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Alice Giannoni
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi" (DEI), University of Bologna, Bologna, Italy
| | | | - Giovanna Lopane
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Giovanna Calandra-Buonaura
- Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Pietro Cortelli
- Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Lorenzo Chiari
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi" (DEI), University of Bologna, Bologna, Italy
- Health Sciences and Technologies - Interdepartmental Center for Industrial Research (CIRI-SDV), University of Bologna, Bologna, Italy
| | - Luca Palmerini
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi" (DEI), University of Bologna, Bologna, Italy
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Gülşen Ç, Koçer B, Söke F, Özcan Gülşen E, Yılmaz Ö, Çomoğlu SS. The effect of deep brain stimulation on lower extremity dexterity in people with Parkinson's disease. Disabil Rehabil 2024:1-6. [PMID: 38375675 DOI: 10.1080/09638288.2024.2317997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 02/08/2024] [Indexed: 02/21/2024]
Abstract
PURPOSE To examine the effect of deep brain stimulation (DBS) on lower extremity dexterity in people with Parkinson's disease (PwPD) and to investigate the relationship between this effect and the effect of DBS on measures of different walking characteristics, and other features of Parkinson's disease. MATERIALS AND METHODS Thirty-six PwPD were included. Assessment was performed twice with DBS "on" and DBS "off" state. RESULTS The LEDT scores of both extremities, the Unified Parkinson Disease Rating Scale-motor section (UPDRS-III), the 10-Meter Walk Test (TMWT), the Timed Up and Go Test (TUG), the Figure-of-Eight Walk Test (FEWT), and the Three-Meter Backward Walk Test (TMBWT) scores were significantly better in "on" DBS condition than "off" DBS condition. The effect of DBS on lower extremity dexterity is related to age and levodopa equivalent daily dosage (LEDD). The effect of DBS on lower extremity dexterity and the effect of DBS on the bradykinesia, TUG, the FEWT, and the TMBWT were also related. CONCLUSIONS DBS has a positive effect on lower extremity dexterity. Clinical characteristics such as age and LEDD and the effect of DBS on bradykinesia, walking with turning, curved walking, and backward walking is related with the effect of DBS on lower extremity dexterity.
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Affiliation(s)
- Çağrı Gülşen
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Bilge Koçer
- Neurology Clinic, Ankara Dışkapı Yıldırım Beyazıt Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Fatih Söke
- Gülhane Faculty of Physiotherapy and Rehabilitation, University of Health Sciences, Ankara, Turkey
| | - Elvan Özcan Gülşen
- Department of Health Care Services, Program in Geriatric Care, Yunus Emre Vocational School, Anadolu University, Eskişehir, Turkey
| | - Öznur Yılmaz
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Selim Selçuk Çomoğlu
- Neurology Clinic, Ankara Dışkapı Yıldırım Beyazıt Training and Research Hospital, University of Health Sciences, Ankara, Turkey
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Tripathi R, McKay JL, Factor SA, Esper CD, Bernhard D, Testini P, Miocinovic S. Impact of deep brain stimulation on gait in Parkinson disease: A kinematic study. Gait Posture 2024; 108:151-156. [PMID: 38070393 DOI: 10.1016/j.gaitpost.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 11/06/2023] [Accepted: 12/05/2023] [Indexed: 02/02/2024]
Abstract
BACKGROUND The effect of Deep Brain Stimulation (DBS) on gait in Parkinson's Disease (PD) is poorly understood. Kinematic studies utilizing quantitative gait outcomes such as speed, cadence, and stride length have shown mixed results and were done mostly before and after acute DBS discontinuation. OBJECTIVE To examine longitudinal changes in kinematic gait outcomes before and after DBS surgery. METHOD We retrospectively assessed changes in quantitative gait outcomes via motion capture in 22 PD patients before and after subthalamic (STN) or globus pallidus internus (GPi) DBS, in on medication state. Associations between gait outcomes and clinical variables were also assessed. RESULT Gait speed reduced from 110.7 ± 21.3 cm/s before surgery to 93.6 ± 24.9 after surgery (7.7 ± 2.9 months post-surgery, duration between assessments was 15.0 ± 3.8 months). Cadence, step length, stride length, and single support time reduced, while total support time, and initial double support time increased. Despite this, there was overall improvement in the Movement Disorder Society-Unified Parkinson Disease Rating Scale-Part III score "on medication/on stimulation" score (from 19.8 ± 10.7-13.9 ± 8.6). Change of gait speed was not related to changes in levodopa dosage, disease duration, unilateral vs bilateral stimulation, or target nucleus. CONCLUSION Quantitative gait outcomes in on medication state worsened after chronic DBS therapy despite improvement in other clinical outcomes. Whether these changes reflect the effects of DBS as opposed to ongoing disease progression is unknown.
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Affiliation(s)
- Richa Tripathi
- Jean & Paul Amos PD & Movement Disorders Program, Department of Neurology, Emory University School of Medicine, United States.
| | - J Lucas McKay
- Jean & Paul Amos PD & Movement Disorders Program, Department of Neurology, Emory University School of Medicine, United States; Department of Biomedical Informatics, Emory University School of Medicine, United States; Wallace H. Coulter Department of Biomedical Engineering, Emory University and Georgia Tech, United States
| | - Stewart A Factor
- Jean & Paul Amos PD & Movement Disorders Program, Department of Neurology, Emory University School of Medicine, United States
| | - Christine D Esper
- Jean & Paul Amos PD & Movement Disorders Program, Department of Neurology, Emory University School of Medicine, United States
| | - Douglas Bernhard
- Jean & Paul Amos PD & Movement Disorders Program, Department of Neurology, Emory University School of Medicine, United States
| | - Paola Testini
- Jean & Paul Amos PD & Movement Disorders Program, Department of Neurology, Emory University School of Medicine, United States
| | - Svjetlana Miocinovic
- Jean & Paul Amos PD & Movement Disorders Program, Department of Neurology, Emory University School of Medicine, United States; Wallace H. Coulter Department of Biomedical Engineering, Emory University and Georgia Tech, United States
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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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Cavallieri F, Campanini I, Gessani A, Budriesi C, Fioravanti V, Di Rauso G, Feletti A, Damiano B, Scaltriti S, Guagnano N, Bardi E, Corni MG, Rossi J, Antonelli F, Cavalleri F, Molinari MA, Contardi S, Menozzi E, Puzzolante A, Vannozzi G, Bergamini E, Pavesi G, Meoni S, Fraix V, Fraternali A, Versari A, Lusuardi M, Biagini G, Merlo A, Moro E, Valzania F. Long-term effects of bilateral subthalamic nucleus deep brain stimulation on gait disorders in Parkinson's disease: a clinical-instrumental study. J Neurol 2023; 270:4342-4353. [PMID: 37208527 DOI: 10.1007/s00415-023-11780-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 04/21/2023] [Accepted: 05/12/2023] [Indexed: 05/21/2023]
Abstract
OBJECTIVE To assess the long-term effects of bilateral subthalamic nucleus deep brain stimulation (STN-DBS) on gait in a cohort of advanced Parkinson's Disease (PD) patients. METHODS This observational study included consecutive PD patients treated with bilateral STN-DBS. Different stimulation and drug treatment conditions were assessed: on-stimulation/off-medication, off-stimulation/off-medication, and on-stimulation/on-medication. Each patient performed the instrumented Timed Up and Go test (iTUG). The instrumental evaluation of walking ability was carried out with a wearable inertial sensor containing a three-dimensional (3D) accelerometer, gyroscope, and magnetometer. This device could provide 3D linear acceleration, angular velocity, and magnetic field vector. Disease motor severity was evaluated with the total score and subscores of the Unified Parkinson Disease Rating Scale part III. RESULTS Twenty-five PD patients with a 5-years median follow-up after surgery (range 3-7) were included (18 men; mean disease duration at surgery 10.44 ± 4.62 years; mean age at surgery 58.40 ± 5.73 years). Both stimulation and medication reduced the total duration of the iTUG and most of its different phases, suggesting a long-term beneficial effect on gait after surgery. However, comparing the two treatments, dopaminergic therapy had a more marked effect in all test phases. STN-DBS alone reduced total iTUG duration, sit-to-stand, and second turn phases duration, while it had a lower effect on stand-to-sit, first turn, forward walking, and walking backward phases duration. CONCLUSIONS This study highlighted that in the long-term after surgery, STN-DBS may contribute to gait and postural control improvement when used together with dopamine replacement therapy, which still shows a substantial beneficial effect.
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Affiliation(s)
- Francesco Cavallieri
- Neuromotor and Rehabilitation Department, Neurology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Isabella Campanini
- LAM-Motion Analysis Laboratory, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS Di Reggio Emilia, S. Sebastiano Hospital, Correggio, Italy.
| | - Annalisa Gessani
- Department of Neuroscience, Neurology Unit, S. Agostino Estense Hospital, AziendaOspedaliero-Universitaria di Modena, Modena, Italy
| | - Carla Budriesi
- Department of Neuroscience, Neurology Unit, S. Agostino Estense Hospital, AziendaOspedaliero-Universitaria di Modena, Modena, Italy
| | - Valentina Fioravanti
- Neuromotor and Rehabilitation Department, Neurology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giulia Di Rauso
- Neuromotor and Rehabilitation Department, Neurology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Department of Neuroscience, Neurology Unit, S. Agostino Estense Hospital, AziendaOspedaliero-Universitaria di Modena, Modena, Italy
| | - Alberto Feletti
- Department of Neurosciences, Biomedicine, and Movement Sciences, Institute of Neurosurgery, University of Verona, Verona, Italy
- Neurosurgery Unit, Azienda Ospedaliero-Universitaria of Modena, Ospedale Civile Baggiovara (OCB) Hospital, Modena, Italy
| | - Benedetta Damiano
- LAM-Motion Analysis Laboratory, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS Di Reggio Emilia, S. Sebastiano Hospital, Correggio, Italy
| | - Sara Scaltriti
- LAM-Motion Analysis Laboratory, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS Di Reggio Emilia, S. Sebastiano Hospital, Correggio, Italy
| | - Noemi Guagnano
- LAM-Motion Analysis Laboratory, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS Di Reggio Emilia, S. Sebastiano Hospital, Correggio, Italy
| | - Elisa Bardi
- Department of Neuroscience, Neurology Unit, S. Agostino Estense Hospital, AziendaOspedaliero-Universitaria di Modena, Modena, Italy
| | - Maria Giulia Corni
- Department of Neuroscience, Neurology Unit, S. Agostino Estense Hospital, AziendaOspedaliero-Universitaria di Modena, Modena, Italy
| | - Jessica Rossi
- Neuromotor and Rehabilitation Department, Neurology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Francesca Antonelli
- Department of Neuroscience, Neurology Unit, S. Agostino Estense Hospital, AziendaOspedaliero-Universitaria di Modena, Modena, Italy
| | - Francesca Cavalleri
- Division of Neuroradiology, Department of Neuroscience, Nuovo Ospedale Civile S. Agostino Estense, Modena, Italy
| | - Maria Angela Molinari
- Department of Neuroscience, Neurology Unit, S. Agostino Estense Hospital, AziendaOspedaliero-Universitaria di Modena, Modena, Italy
| | - Sara Contardi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore, Bologna, Italy
| | - Elisa Menozzi
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK
| | - Annette Puzzolante
- Neurosurgery Unit, Azienda Ospedaliero-Universitaria of Modena, Ospedale Civile Baggiovara (OCB) Hospital, Modena, Italy
| | - Giuseppe Vannozzi
- Laboratory of Bioengineering and Neuromechanics, Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - Elena Bergamini
- Laboratory of Bioengineering and Neuromechanics, Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - Giacomo Pavesi
- Neurosurgery Unit, Azienda Ospedaliero-Universitaria of Modena, Ospedale Civile Baggiovara (OCB) Hospital, Modena, Italy
| | - Sara Meoni
- Division of Neurology, Grenoble Alpes University, Centre HospitalierUniversitaire de Grenoble, Grenoble Institute of Neuroscience, Grenoble, France
| | - Valérie Fraix
- Division of Neurology, Grenoble Alpes University, Centre HospitalierUniversitaire de Grenoble, Grenoble Institute of Neuroscience, Grenoble, France
| | | | - Annibale Versari
- Nuclear Medicine Unit, Azienda Unità Sanitaria Locale IRCCS, Reggio Emilia, Italy
| | - Mirco Lusuardi
- Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, 42015, Reggio Emilia, Italy
| | - Giuseppe Biagini
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Andrea Merlo
- LAM-Motion Analysis Laboratory, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS Di Reggio Emilia, S. Sebastiano Hospital, Correggio, Italy
| | - Elena Moro
- Division of Neurology, Grenoble Alpes University, Centre HospitalierUniversitaire de Grenoble, Grenoble Institute of Neuroscience, Grenoble, France
| | - Franco Valzania
- Neuromotor and Rehabilitation Department, Neurology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Ghislieri M, Lanotte M, Knaflitz M, Rizzi L, Agostini V. Muscle synergies in Parkinson's disease before and after the deep brain stimulation of the bilateral subthalamic nucleus. Sci Rep 2023; 13:6997. [PMID: 37117317 PMCID: PMC10147693 DOI: 10.1038/s41598-023-34151-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 04/25/2023] [Indexed: 04/30/2023] Open
Abstract
The aim of this study is to quantitatively assess motor control changes in Parkinson's disease (PD) patients after bilateral deep brain stimulation of the subthalamic nucleus (STN-DBS), based on a novel muscle synergy evaluation approach. A group of 20 PD patients evaluated at baseline (before surgery, T0), at 3 months (T1), and at 12 months (T2) after STN-DBS surgery, as well as a group of 20 age-matched healthy control subjects, underwent an instrumented gait analysis, including surface electromyography recordings from 12 muscles. A smaller number of muscle synergies was found in PD patients (4 muscle synergies, at each time point) compared to control subjects (5 muscle synergies). The neuromuscular robustness of PD patients-that at T0 was smaller with respect to controls (PD T0: 69.3 ± 2.2% vs. Controls: 77.6 ± 1.8%, p = 0.004)-increased at T1 (75.8 ± 1.8%), becoming not different from that of controls at T2 (77.5 ± 1.9%). The muscle synergies analysis may offer clinicians new knowledge on the neuromuscular structure underlying PD motor types of behavior and how they can improve after electroceutical STN-DBS therapy.
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Affiliation(s)
- Marco Ghislieri
- Department of Electronics and Telecommunications, Politecnico di Torino, 10129, Turin, Italy.
- PolitoBIOMed Lab, Politecnico di Torino, 10129, Turin, Italy.
| | - Michele Lanotte
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, 10126, Turin, Italy
- AOU Città della Salute e della Scienza di Torino, 10126, Turin, Italy
| | - Marco Knaflitz
- Department of Electronics and Telecommunications, Politecnico di Torino, 10129, Turin, Italy
- PolitoBIOMed Lab, Politecnico di Torino, 10129, Turin, Italy
| | - Laura Rizzi
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, 10126, Turin, Italy
- AOU Città della Salute e della Scienza di Torino, 10126, Turin, Italy
| | - Valentina Agostini
- Department of Electronics and Telecommunications, Politecnico di Torino, 10129, Turin, Italy
- PolitoBIOMed Lab, Politecnico di Torino, 10129, Turin, Italy
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Xie J, Li T, He T, Xu R, Zhang X, Wang X, Geng X. Deep brain stimulation on the external segment of the globus pallidus improves the electrical activity of internal segment of globus pallidus in a rat model of Parkinson's disease. Brain Res 2022; 1797:148115. [PMID: 36202223 DOI: 10.1016/j.brainres.2022.148115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 08/29/2022] [Accepted: 09/30/2022] [Indexed: 11/19/2022]
Abstract
Parkinson's disease (PD) is a progressive neurodegenerative disorder characterized by the progressive degeneration of neurons in the substantia nigra pars compacta. Deep brain stimulation (DBS) is an effective treatment for PD cardinal motor symptoms. DBS of GPe has been recognized as an effective treatment option for motor symptoms of PD, but the mechanism is still essentially unknown. To investigate the impact of DBS in the external segment of globus pallidus (GPe) on the pathway of the basal ganglia (BG), we recorded the electrical activities of single neurons and local field potential (LFP) of the internal segment of globus pallidus (GPi). The results showed that the firing rate of GPi neurons in the 6-OHDA lesioned rats returned to the normal level after GPe-DBS for two weeks. Moreover, the CV value of GPi neurons is significantly lower than that in the PD group. The different frequency bands of GPi LFP in PD rats have improved correspondingly. These findings indicate that the improvement of the electrical activity of GPi by GPe-DBS in PD rats may be an important electrophysiological mechanism for treating PD.
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Affiliation(s)
- Jinlu Xie
- Key Laboratory of Vector Biology and Pathogen Control of Zhejiang Province, School of Medicine, Huzhou University, Huzhou Central Hospital, Huzhou 313000, China.
| | - Tao Li
- Key Laboratory of Vector Biology and Pathogen Control of Zhejiang Province, School of Medicine, Huzhou University, Huzhou Central Hospital, Huzhou 313000, China
| | - Tingting He
- Key Laboratory of Biomedical Engineering of Ministry of Education, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou 310027, China
| | - Rong Xu
- The 72nd Group Army Hospital of the PLA Army, Huzhou 313000, Zhejiang Province, China
| | - Xianshan Zhang
- Key Laboratory of Vector Biology and Pathogen Control of Zhejiang Province, School of Medicine, Huzhou University, Huzhou Central Hospital, Huzhou 313000, China
| | - Xuenan Wang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai 200030, China.
| | - Xiwen Geng
- Experimental Centre, Shandong University of Traditional Chinese Medicine, Jinan 250355, Shandong Province, China.
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Kelemen A, Halász L, Muthuraman M, Erőss L, Barsi P, Zádori D, Laczó B, Kis D, Klivényi P, Fekete G, Bognár L, Bereczki D, Tamás G. Clinical parameters predict the effect of bilateral subthalamic stimulation on dynamic balance parameters during gait in Parkinson's disease. Front Neurol 2022; 13:917187. [PMID: 36226087 PMCID: PMC9549153 DOI: 10.3389/fneur.2022.917187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 08/29/2022] [Indexed: 11/23/2022] Open
Abstract
We investigated the effect of deep brain stimulation on dynamic balance during gait in Parkinson's disease with motion sensor measurements and predicted their values from disease-related factors. We recruited twenty patients with Parkinson's disease treated with bilateral subthalamic stimulation for at least 12 months and 24 healthy controls. Six monitors with three-dimensional gyroscopes and accelerometers were placed on the chest, the lumbar region, the two wrists, and the shins. Patients performed the instrumented Timed Up and Go test in stimulation OFF, stimulation ON, and right- and left-sided stimulation ON conditions. Gait parameters and dynamic balance parameters such as double support, peak turn velocity, and the trunk's range of motion and velocity in three dimensions were analyzed. Age, disease duration, the time elapsed after implantation, the Hoehn-Yahr stage before and after the operation, the levodopa, and stimulation responsiveness were reported. We individually calculated the distance values of stimulation locations from the subthalamic motor center in three dimensions. Sway values of static balance were collected. We compared the gait parameters in the OFF and stimulation ON states and controls. With cluster analysis and a machine-learning-based multiple regression method, we explored the predictive clinical factors for each dynamic balance parameter (with age as a confounder). The arm movements improved the most among gait parameters due to stimulation and the horizontal and sagittal trunk movements. Double support did not change after switching on the stimulation on the group level and did not differ from control values. Individual changes in double support and horizontal range of trunk motion due to stimulation could be predicted from the most disease-related factors and the severity of the disease; the latter also from the stimulation-related changes in the static balance parameters. Physiotherapy should focus on double support and horizontal trunk movements when treating patients with subthalamic deep brain stimulation.
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Affiliation(s)
- Andrea Kelemen
- Department of Neurology, Semmelweis University, Budapest, Hungary
| | - László Halász
- National Institute of Clinical Neurosciences, Budapest, Hungary
| | - Muthuraman Muthuraman
- Biomedical Statistics and Multimodal Signal Processing Unit, Department of Neurology, University Medical Center of Johannes Gutenberg University Mainz, Mainz, Germany
| | - Loránd Erőss
- National Institute of Clinical Neurosciences, Budapest, Hungary
| | - Péter Barsi
- Department of Neuroradiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Dénes Zádori
- Department of Neurology, University of Szeged, Szeged, Hungary
| | - Bence Laczó
- Department of Neurology, University of Szeged, Szeged, Hungary
| | - Dávid Kis
- Department of Neurosurgery, University of Szeged, Szeged, Hungary
| | - Péter Klivényi
- Department of Neurology, University of Szeged, Szeged, Hungary
| | - Gábor Fekete
- Department of Neurosurgery, University of Debrecen, Debrecen, Hungary
| | - László Bognár
- Department of Neurosurgery, University of Debrecen, Debrecen, Hungary
| | - Dániel Bereczki
- Department of Neurology, Semmelweis University, Budapest, Hungary
| | - Gertrúd Tamás
- Department of Neurology, Semmelweis University, Budapest, Hungary
- *Correspondence: Gertrúd Tamás
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9
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Cabañes-Martínez L, Villadóniga M, Millán AS, Del Álamo M, Regidor I. Effects of deep brain stimulation on the kinematics of gait and balance in patients with idiopathic Parkinson's disease. Clin Biomech (Bristol, Avon) 2022; 98:105737. [PMID: 35998434 DOI: 10.1016/j.clinbiomech.2022.105737] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 07/13/2022] [Accepted: 08/09/2022] [Indexed: 02/07/2023]
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.
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Affiliation(s)
- Lidia Cabañes-Martínez
- Clinical Neurophysiology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain.
| | - Marta Villadóniga
- Clinical Neurophysiology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Marta Del Álamo
- Neurosurgery Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Ignacio Regidor
- Clinical Neurophysiology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
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10
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Bange M, Gonzalez-Escamilla G, Lang NSC, Ding H, Radetz A, Herz DM, Schöllhorn WI, Muthuraman M, Groppa S. Gait Abnormalities in Parkinson's Disease Are Associated with Extracellular Free-Water Characteristics in the Substantia Nigra. JOURNAL OF PARKINSON'S DISEASE 2022; 12:1575-1590. [PMID: 35570500 DOI: 10.3233/jpd-223225] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Gait impairments are common in Parkinson's disease (PD). The pathological mechanisms are complex and not thoroughly elucidated, thus quantitative and objective parameters that closely relate to gait characteristics are critically needed to improve the diagnostic assessments and monitor disease progression. The substantia nigra is a relay structure within basal ganglia brainstem loops that is centrally involved in gait modulation. OBJECTIVE We tested the hypothesis that quantitative gait biomechanics are related to the microstructural integrity of the substantia nigra and PD-relevant gait abnormalities are independent from bradykinesia-linked speed reductions. METHODS Thirty-eight PD patients and 33 age-matched control participants walked on a treadmill at fixed speeds. Gait parameters were fed into a principal component analysis to delineate relevant features. We applied the neurite orientation dispersion and density imaging (NODDI) model on diffusion-weighted MR-images to calculate the free-water content as an advanced marker of microstructural integrity of the substantia nigra and tested its associations with gait parameters. RESULTS Patients showed increased duration of stance phase, load response, pre-swing, and double support time, as well as reduced duration of single support and swing time. Gait rhythmic alterations associated positively with the free-water content in the right substantia nigra in PD, indicating that patients with more severe neurodegeneration extend the duration of stance phase, load response, and pre-swing. CONCLUSION The results provide evidence that gait alterations are not merely a byproduct of bradykinesia-related reduced walking speed. The data-supported association between free-water and the rhythmic component highlights the potential of substantia nigra microstructure imaging as a measure of gait-dysfunction and disease-progression.
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Affiliation(s)
- Manuel Bange
- Section of Movement Disorders and Neurostimulation, Department of Neurology, Focus Program Translational Neuroscience (FTN), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Gabriel Gonzalez-Escamilla
- Section of Movement Disorders and Neurostimulation, Department of Neurology, Focus Program Translational Neuroscience (FTN), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Nadine Sandra Claudia Lang
- Section of Movement Disorders and Neurostimulation, Department of Neurology, Focus Program Translational Neuroscience (FTN), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Hao Ding
- Section of Movement Disorders and Neurostimulation, Department of Neurology, Focus Program Translational Neuroscience (FTN), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Angela Radetz
- Section of Movement Disorders and Neurostimulation, Department of Neurology, Focus Program Translational Neuroscience (FTN), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Damian Marc Herz
- Section of Movement Disorders and Neurostimulation, Department of Neurology, Focus Program Translational Neuroscience (FTN), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
- MRC Brain Network Dynamics Unit at the University of Oxford, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | | | - Muthuraman Muthuraman
- Section of Movement Disorders and Neurostimulation, Department of Neurology, Focus Program Translational Neuroscience (FTN), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Sergiu Groppa
- Section of Movement Disorders and Neurostimulation, Department of Neurology, Focus Program Translational Neuroscience (FTN), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
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11
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Ravi DK, Baumann CR, Bernasconi E, Gwerder M, Ignasiak NK, Uhl M, Stieglitz L, Taylor WR, Singh NB. Does Subthalamic Deep Brain Stimulation Impact Asymmetry and Dyscoordination of Gait in Parkinson's Disease? Neurorehabil Neural Repair 2021; 35:1020-1029. [PMID: 34551639 PMCID: PMC8593318 DOI: 10.1177/15459683211041309] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Subthalamic deep brain stimulation (STN-DBS) is an effective treatment for selected Parkinson's disease (PD) patients. Gait characteristics are often altered after surgery, but quantitative therapeutic effects are poorly described. Objective. The goal of this study was to systematically investigate modifications in asymmetry and dyscoordination of gait 6 months postoperatively in patients with PD and compare the outcomes with preoperative baseline and to asymptomatic controls without PD. Methods. A convenience sample of thirty-two patients with PD (19 with postural instability and gait disorder (PIGD) type and 13 with tremor dominant disease) and 51 asymptomatic controls participated. Parkinson patients were tested prior to the surgery in both OFF and ON medication states, and 6-months postoperatively in the ON stimulation condition. Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) I to IV and medication were compared to preoperative conditions. Asymmetry ratios, phase coordination index, and walking speed were assessed. Results. MDS-UPDRS I to IV at 6 months improved significantly, and levodopa equivalent daily dosages significantly decreased. STN-DBS increased step time asymmetry (hedges' g effect sizes [95% confidence interval] between pre- and post-surgery: .27 [-.13, .73]) and phase coordination index (.29 [-.08, .67]). These effects were higher in the PIGD subgroup than the tremor dominant (step time asymmetry: .38 [-.06, .90] vs .09 [-.83, 1.0] and phase coordination index: .39 [-.04, .84] vs .13 [-.76, .96]). Conclusions. This study provides objective evidence of how STN-DBS increases asymmetry and dyscoordination of gait in patients with PD and suggests motor subtypes-associated differences in the treatment response.
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Affiliation(s)
- Deepak K Ravi
- Institute for Biomechanics, ETH Zürich, Zürich, Switzerland
| | | | | | | | - Niklas K Ignasiak
- Department of Physical Therapy, 6226Chapman University, Irvine, CA, USA
| | - Mechtild Uhl
- Department of Neurology, University Hospital Zürich, Zürich, Switzerland
| | - Lennart Stieglitz
- Department of Neurology, University Hospital Zürich, Zürich, Switzerland
| | | | - Navrag B Singh
- Institute for Biomechanics, ETH Zürich, Zürich, Switzerland
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12
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Schniepp R, Möhwald K, Wuehr M. [Options for the symptomatic treatment of chronic neurological gait disorders]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2021; 89:243-253. [PMID: 33893628 DOI: 10.1055/a-1472-5860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Gait and mobility impairments are common and relevant in patients with chronic neurological disorders. It reduces the health-related quality of life and induces falls with morbidity. Symptomatic treatment options are therefore necessary in order to improve the health status of patients with neurological disorders.By means of a selective literature research focusing on studies with specific gait-related outcome measures. We discuss the differential treatment options for (1) hypokinetic gait disorders (Parkinson´s disease, Normal pressure hydrocephalus, vascular encephalopathy), (2) gait unsteadiness with ataxia (sensory and cerebellar ataxia), and (3) gait with spasticity and paresis (due to multiple sclerosis). Therapeutical options for the symptomatic treatment of gait disorders comprise non-pharmacological and pharmacological approaches. Both address the functional domains of "locomotion", "postural control", "modulation" and "adaptability" of gait.Pharmacological options are orientated to pathophysiology of the underlying diseases. Supportive physiotherapeutic interventions offer broader and unspecific options for treatment. Clinical conditions that specifically disturb the execution of locomotion or gait can also be addressed by the provision of physical therapy or supportive devices.Effective options for the symptomatic treatment of patients with neurological gait disorders are available. Applications of options addressing the pathophysiology of the underlying disease, a functional domain-based exercise and physiotherapy program, and the provision of walking aides for specific symptoms that further worsen gait performance can be recommended.
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Affiliation(s)
- Roman Schniepp
- Deutsches Schwindel- und Gleichgewichtszentrum, Ludwig-Maximilians Universität München.,Neurologische Klinik, Ludwig-Maximilians Universität München
| | - Ken Möhwald
- Deutsches Schwindel- und Gleichgewichtszentrum, Ludwig-Maximilians Universität München.,Neurologische Klinik, Ludwig-Maximilians Universität München
| | - Max Wuehr
- Deutsches Schwindel- und Gleichgewichtszentrum, Ludwig-Maximilians Universität München
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13
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Beheshti I, Ko JH. Modulating brain networks associated with cognitive deficits in Parkinson's disease. Mol Med 2021; 27:24. [PMID: 33691622 PMCID: PMC7945662 DOI: 10.1186/s10020-021-00284-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/02/2021] [Indexed: 12/12/2022] Open
Abstract
Parkinson's disease (PD) is a relatively well characterised neurological disorder that primarily affects motor and cognitive functions. This paper reviews on how transcranial direct current stimulation (tDCS) can be used to modulate brain networks associated with cognitive deficits in PD. We first provide an overview of brain network abnormalities in PD, by introducing the brain network modulation approaches such as pharmacological interventions and brain stimulation techniques. We then present the potential underlying mechanisms of tDCS technique, and specifically highlight how tDCS can be applied to modulate brain network abnormality associated with cognitive dysfunction among PD patients. More importantly, we address the limitations of existing studies and suggest possible future directions, with the aim of helping researchers to further develop the use of tDCS technique in clinical settings.
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Affiliation(s)
- Iman Beheshti
- Department of Human Anatomy and Cell Science, University of Manitoba, 130-745 Bannatyne Ave., Winnipeg, MB R3E 0J9 Canada
- Kleysen Institute for Advanced Medicine, Health Science Centre, Winnipeg, MB Canada
| | - Ji Hyun Ko
- Department of Human Anatomy and Cell Science, University of Manitoba, 130-745 Bannatyne Ave., Winnipeg, MB R3E 0J9 Canada
- Kleysen Institute for Advanced Medicine, Health Science Centre, Winnipeg, MB Canada
- Graduate Program in Biomedical Engineering, University of Manitoba, Winnipeg, MB Canada
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14
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Hurt CP, Kuhman DJ, Guthrie BL, Lima CR, Wade M, Walker HC. Walking Speed Reliably Measures Clinically Significant Changes in Gait by Directional Deep Brain Stimulation. Front Hum Neurosci 2021; 14:618366. [PMID: 33584227 PMCID: PMC7879982 DOI: 10.3389/fnhum.2020.618366] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 12/17/2020] [Indexed: 12/21/2022] Open
Abstract
Introduction: Although deep brain stimulation (DBS) often improves levodopa-responsive gait symptoms, robust therapies for gait dysfunction from Parkinson's disease (PD) remain a major unmet need. Walking speed could represent a simple, integrated tool to assess DBS efficacy but is often not examined systematically or quantitatively during DBS programming. Here we investigate the reliability and functional significance of changes in gait by directional DBS in the subthalamic nucleus. Methods: Nineteen patients underwent unilateral subthalamic nucleus DBS surgery with an eight-contact directional lead (1-3-3-1 configuration) in the most severely affected hemisphere. They arrived off dopaminergic medications >12 h preoperatively and for device activation 1 month after surgery. We measured a comfortable walking speed using an instrumented walkway with DBS off and at each of 10 stimulation configurations (six directional contacts, two virtual rings, and two circular rings) at the midpoint of the therapeutic window. Repeated measures of ANOVA contrasted preoperative vs. maximum and minimum walking speeds across DBS configurations during device activation. Intraclass correlation coefficients examined walking speed reliability across the four trials within each DBS configuration. We also investigated whether changes in walking speed related to modification of step length vs. cadence with a one-sample t-test. Results: Mean comfortable walking speed improved significantly with DBS on vs. both DBS off and minimum speeds with DBS on (p < 0.001, respectively). Pairwise comparisons showed no significant difference between DBS off and minimum comfortable walking speed with DBS on (p = 1.000). Intraclass correlations were ≥0.949 within each condition. Changes in comfortable walk speed were conferred primarily by changes in step length (p < 0.004). Conclusion: Acute assessment of walking speed is a reliable, clinically meaningful measure of gait function during DBS activation. Directional and circular unilateral subthalamic DBS in appropriate configurations elicit acute and clinically significant improvements in gait dysfunction related to PD. Next-generation directional DBS technologies have significant potential to enhance gait by individually tailoring stimulation parameters to optimize efficacy.
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Affiliation(s)
- Christopher P Hurt
- Rehabilitation Sciences, University of Alabama at Birmingham, Birmingham, AL, United States.,Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Daniel J Kuhman
- Rehabilitation Sciences, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Barton L Guthrie
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Carla R Lima
- Rehabilitation Sciences, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Melissa Wade
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Harrison C Walker
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, United States.,Department of Biomedical Engineering, University of Alabama at Birmingham, Birmingham, AL, United States
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15
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Smith MD, Brazier DE, Henderson EJ. Current Perspectives on the Assessment and Management of Gait Disorders in Parkinson's Disease. Neuropsychiatr Dis Treat 2021; 17:2965-2985. [PMID: 34584414 PMCID: PMC8464370 DOI: 10.2147/ndt.s304567] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 08/25/2021] [Indexed: 12/31/2022] Open
Abstract
Gait dysfunction is a key defining feature of Parkinson's disease (PD), and is associated with symptoms of freezing and an increased risk of falls. In this narrative review, we cover the putative mechanisms of gait dysfunction in PD, the assessment of gait abnormalities, and the management of symptoms caused by the inherent difficulty in walking. Our understanding of the causes of gait problems in PD has progressed in recent times, moving from neurocognitive theory to correlates of affected neuronal pathways. In particular, this can be shown to correspond with abnormalities in responses to dual-task paradigms and dysfunction in cholinergic signaling. Great progress has been made in the sophistication and precision of gait assessment; however, it has firmly remained in the research domain. There is significant momentum behind wearable technologies that can be used by patients in their own environment, acting as digital biomarkers that can not only reflect progression but also independently discriminate PD from non-PD individuals. The treatment of gait dysfunction has historically relied on physical therapies and training combined with a view to mitigating the impact of such consequences as falls. Pharmacological therapies that are the mainstay of treatment in PD have tended to address symptoms like bradykinesia; however, optimization of dopaminergic therapies likely has a positive effect on quality of gait. Other targets have been assessed with the goal of improving gait, of which medications that improve cholinergic signaling appear most promising. Neuromodulation techniques are increasingly used in the form of deep-brain stimulation; however, standard targets, such as the globus pallidus interna, have a modest effect on gait. Considerable benefit has been seen through targeting the pedunculopontine nucleus, and a dual-target approach may be warranted. Stimulation of the spinal cord and brain through direct or magnetic approaches has been assessed, but requires further evidence.
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Affiliation(s)
- Matthew D Smith
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Older People's Unit, Royal United Hospital NHS Foundation Trust, Bath, UK
| | - Danielle E Brazier
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Emily J Henderson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Older People's Unit, Royal United Hospital NHS Foundation Trust, Bath, UK
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16
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Gait variability is linked to the atrophy of the Nucleus Basalis of Meynert and is resistant to STN DBS in Parkinson's disease. Neurobiol Dis 2020; 146:105134. [PMID: 33045357 PMCID: PMC7711311 DOI: 10.1016/j.nbd.2020.105134] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/26/2020] [Accepted: 10/06/2020] [Indexed: 12/11/2022] Open
Abstract
Parkinson’s disease (PD) is a systemic brain disorder where the cortical cholinergic network begins to degenerate early in the disease process. Readily accessible, quantitative, and specific behavioral markers of the cortical cholinergic network are lacking. Although degeneration of the dopaminergic network may be responsible for deficits in cardinal motor signs, the control of gait is a complex process and control of higher-order aspects of gait, such as gait variability, may be influenced by cognitive processes attributed to cholinergic networks. We investigated whether swing time variability, a metric of gait variability that is independent from gait speed, was a quantitative behavioral marker of cortical cholinergic network integrity in PD. Twenty-two individuals with PD and subthalamic nucleus (STN) deep brain stimulation (PD-DBS cohort) and twenty-nine age-matched controls performed a validated stepping-in-place (SIP) task to assess swing time variability off all therapy. The PD-DBS cohort underwent structural MRI scans to measure gray matter volume of the Nucleus Basalis of Meynert (NBM), the key node in the cortical cholinergic network. In order to determine the role of the dopaminergic system on swing time variability, it was measured ON and OFF STN DBS in the PD-DBS cohort, and on and off dopaminergic medication in a second PD cohort of thirty-two individuals (PD-med). A subset of eleven individuals in the PD-DBS cohort completed the SIP task again off all therapy after three years of continuous DBS to assess progression of gait impairment. Swing time variability was significantly greater (i.e., worse) in PD compared to controls and greater swing time variability was related to greater atrophy of the NBM, as was gait speed. STN DBS significantly improved cardinal motor signs and gait speed but did not improve swing time variability, which was replicated in the second cohort using dopaminergic medication. Swing time variability continued to worsen in PD, off therapy, after three years of continuous STN DBS, and NBM atrophy showed a trend for predicting the degree of increase. In contrast, cardinal motor signs did not progress. These results demonstrate that swing time variability is a reliable marker of cortical cholinergic health, and support a framework in which higher-order aspects of gait control in PD are reliant on the cortical cholinergic system, in contrast to other motor aspects of PD that rely on the dopaminergic network.
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17
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Effect of Parkinson's disease and two therapeutic interventions on muscle activity during walking: a systematic review. NPJ PARKINSONS DISEASE 2020; 6:22. [PMID: 32964107 PMCID: PMC7481232 DOI: 10.1038/s41531-020-00119-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 07/09/2020] [Indexed: 12/26/2022]
Abstract
Gait deficits are a common feature of Parkinson’s disease (PD) and predictors of future motor and cognitive impairment. Understanding how muscle activity contributes to gait impairment and effects of therapeutic interventions on motor behaviour is crucial for identifying potential biomarkers and developing rehabilitation strategies. This article reviews sixteen studies that investigate the electromyographic (EMG) activity of lower limb muscles in people with PD during walking and reports on their quality. The weight of evidence establishing differences in motor activity between people with PD and healthy older adults (HOAs) is considered. Additionally, the effect of dopaminergic medication and deep brain stimulation (DBS) on modifying motor activity is assessed. Results indicated greater proximal and decreased distal activity of lower limb muscles during walking in individuals with PD compared to HOA. Dopaminergic medication was associated with increased distal lower limb muscle activity whereas subthalamic nucleus DBS increased activity of both proximal and distal lower limb muscles. Tibialis anterior was impacted most by the interventions. Quality of the studies was not strong, with a median score of 61%. Most studies investigated only distal muscles, involved small sample sizes, extracted limited EMG features and lacked rigorous signal processing. Few studies related changes in motor activity with functional gait measures. Understanding mechanisms underpinning gait impairment in PD is essential for development of personalised rehabilitative interventions. Recommendations for future studies include greater participant numbers, recording more functionally diverse muscles, applying multi-muscle analyses, and relating EMG to functional gait measures.
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18
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Shin HW, Kim MS, Kim SR, Jeon SR, Chung SJ. Long-term Effects of Bilateral Subthalamic Deep Brain Stimulation on Postural Instability and Gait Difficulty in Patients with Parkinson's Disease. J Mov Disord 2020; 13:127-132. [PMID: 32498496 PMCID: PMC7280933 DOI: 10.14802/jmd.19081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 02/27/2020] [Indexed: 11/24/2022] Open
Abstract
Objective The long-term effects of bilateral subthalamic nucleus deep brain stimulation (STN-DBS) on postural instability and gait difficulty (PIGD) in patients with Parkinson’s disease (PD) remain unclear. In this study, we aimed to evaluate the longterm effects of STN-DBS surgery on PIGD symptoms in patients with advanced-stage PD. Methods This study included 49 consecutively included patients with PD who underwent bilateral STN-DBS. The Unified Parkinson’s Disease Rating Scale (UPDRS) scores and subscores for PIGD were assessed at baseline and at 1, 3, and 5 years postoperatively. The PIGD subscore was divided into PIGD-motor and PIGD-activities of daily living (ADL) scores according to parts III and II of the UPDRS, respectively. Results The PIGD-motor and PIGD-ADL scores at the “medication-off” state improved at 3 and 5 years, respectively. Overall, the UPDRS III and II scores at “medication-off” improved at 5 years. The UPDRS IV score also significantly improved and the levodopa equivalent daily dosage decreased at all follow-ups. Finally, the PIGD-motor score at baseline was able to predict long-term improvement in the PIGD-motor score at the 5-year follow-up. Conclusion The STN-DBS has both short- and long-term effects on PIGD, as well as overall motor function, in patients with advanced PD. The degree of PIGD at the preoperative evaluation can be used to predict long-term outcomes after STN-DBS surgery.
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Affiliation(s)
- Hae-Won Shin
- Department of Neurology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Mi Sun Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | | | - Sang Ryong Jeon
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sun Ju Chung
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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19
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Wegrzyk J, Armand S, Catalano Chiuvé S, Burkhard PR, Allali G. Education level affects dual-task gait after deep brain stimulation in Parkinson's disease. Parkinsonism Relat Disord 2019; 68:65-68. [PMID: 31621623 DOI: 10.1016/j.parkreldis.2019.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 09/30/2019] [Accepted: 10/05/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION High cognitive reserve is associated with milder cognitive and motor deficits in Parkinson's disease (PD). We investigated whether educational status (as a proxy for cognitive reserve) could modulate dual-task (DT) related gait changes after subthalamic nucleus deep brain stimulation (STN-DBS) in PD. METHODS DT-related gait changes were assessed in 34 PD patients (age: 60.5 ± 8.7; % female: 44%), before and one year after STN-DBS. Based on walking speed change after DBS, patients were classified into responders (improvement) and non-responders (deterioration) using automated k-means clustering for four DT (i.e. forward and backward counting; semantic and phonemic fluency). RESULTS Patients with high education level improved DT gait performance compared to lower educated patients (p = 0.03). Baseline cognitive performance, disease progression and stimulation efficiency were similar between groups (i.e. responders versus non-responders). Logistic regression showed an association between responders and high level of education for verbal fluency (semantic/phonemic fluency, beta = 3.9/3.4, p = 0.03). No significant changes for any gait parameter were found using all-group analyses. CONCLUSION Education level is associated with DT-related gait changes in PD one year post-DBS. Subgroup analyses should be considered for highly variable gait outcomes after STN-DBS. With regard to the predominance of motor-cognitive DT performance in everyday life, a high CR could be considered as a favourable inclusion criterion for future DBS candidates.
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Affiliation(s)
- Jennifer Wegrzyk
- Department of Neurology, Geneva University Hospitals, Geneva, Switzerland; Willy Taillard Laboratory of Kinesiology, Geneva University Hospitals and University of Geneva, Geneva, Switzerland; School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland.
| | - Stéphane Armand
- Department of Neurology, Geneva University Hospitals, Geneva, Switzerland; Willy Taillard Laboratory of Kinesiology, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | | | - Pierre R Burkhard
- Department of Neurology, Geneva University Hospitals, Geneva, Switzerland
| | - Gilles Allali
- Department of Neurology, Geneva University Hospitals, Geneva, Switzerland; Department of Neurology, Albert Einstein College of Medicine, Yeshiva University, USA
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Sultanova SG, Fedorova NV, Bril EV, Gamaleya AA, Tomskiy AA. [Deep brain stimulation effect on postural instability and gait disorders in Parkinson's disease]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:123-130. [PMID: 31626229 DOI: 10.17116/jnevro2019119091123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
An effect of deep brain stimulation on postural instability and gait disorders in Parkinson's disease S.G. Sultanova, N.V. Fedorova, E.V. Bril, A.A. Gamaleya, A.A. Tomskiy During the last time, surgical treatment of patients with Parkinson's disease has firmly taken its place in the general algorithm for managing patients with this pathology. Deep brain electrostimulation is the most advanced and promising method, which allows the reduction in the severity of main clinical manifestations of the disease, including axial symptoms. It is noted that certain temporal aspects of parkinsonian gait disorder remain therapeutically resistant. Subthalamic nucleus stimulation was also reported to improve levodopa-responsive freezing of gait. In this review, the authors summarize the effects of deep brain stimulation on gait and postural symptoms.
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Affiliation(s)
- S G Sultanova
- Russian Medical Academy of Continuing Professional Education, Moscow, Russia
| | - N V Fedorova
- Russian Medical Academy of Continuing Professional Education, Moscow, Russia
| | - E V Bril
- Russian Medical Academy of Continuing Professional Education, Moscow, Russia
| | - A A Gamaleya
- Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
| | - A A Tomskiy
- Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
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21
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Brandmeir NJ, Brandmeir CL, Carr D, Kuzma K, McInerney J. Deep Brain Stimulation for Parkinson Disease Does not Worsen or Improve Postural Instability: A Prospective Cohort Trial. Neurosurgery 2019; 83:1173-1182. [PMID: 29444300 DOI: 10.1093/neuros/nyx602] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 11/25/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Falls and postural instability (PI) are major sources of morbidity in Parkinson disease (PD). Deep brain stimulation (DBS) is a major therapy for PD. The effects of DBS on PI and falls remain controversial. OBJECTIVE To study if DBS worsens PI, validated measures of PI (Timed Up and Go, Berg Balance Scale, Unified Parkinson's Disease Rating Scale 3.12 [Pull Test], and the Biodex Sway Index with eyes closed on a firm and soft surface) and reported falls were used to prospectively evaluate the effect of DBS on PI at 3 and 12 mo postoperatively compared to baseline measurements. The primary outcomes were a positive result on 4 out of the 5 PI tests and falls. METHODS Patients presenting for DBS were prospectively enrolled and evaluated at presentation and, 3 and 12 mo postoperatively. All tests were performed at each visit. RESULTS At 3 mo 4 of 5 positive showed noninferiority to baseline, with a rate of 28% vs 41% (relative risk [RR] 0.8 [0.5-1.3]). At 12 mo, 4 of 5 positive had a rate of 35% vs 30% (RR 1.2 [0.8-1.8]) and falls had a rate of 54% vs 46% (RR 1.2 [0.6-2.3]). These did not meet criteria to prove noninferiority. Sensitivity analysis at 12 mo showed noninferiority for 4 of 5 (RR 0.9 [0.6-1.5]) but not falls (RR 1.1 [0.5-2.3]). CONCLUSION This evidence is consistent with the hypothesis that DBS does not worsen PI when measured at 3 and 12 mo postoperatively.
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Affiliation(s)
- Nicholas J Brandmeir
- Blanchette Rockefeller Neuroscience Institute.,West Virginia University Department of Neurosurgery, Morgantown, WV
| | - Cheryl L Brandmeir
- West Virginia University Department of Neurosurgery, Morgantown, WV.,West Virginia University Department of Human Performance, Morgantown, WV
| | - David Carr
- Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Kristine Kuzma
- Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - James McInerney
- Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, PA
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22
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Müller MLTM, Marusic U, van Emde Boas M, Weiss D, Bohnen NI. Treatment options for postural instability and gait difficulties in Parkinson's disease. Expert Rev Neurother 2019; 19:1229-1251. [PMID: 31418599 DOI: 10.1080/14737175.2019.1656067] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Introduction: Gait and balance disorders in Parkinson's disease (PD) represent a major therapeutic challenge as frequent falls and freezing of gait impair quality of life and predict mortality. Limited dopaminergic therapy responses implicate non-dopaminergic mechanisms calling for alternative therapies.Areas covered: The authors provide a review that encompasses pathophysiological changes involved in axial motor impairments in PD, pharmacological approaches, exercise, and physical therapy, improving physical activity levels, invasive and non-invasive neurostimulation, cueing interventions and wearable technology, and cognitive interventions.Expert opinion: There are many promising therapies available that, to a variable degree, affect gait and balance disorders in PD. However, not one therapy is the 'silver bullet' that provides full relief and ultimately meaningfully improves the patient's quality of life. Sedentariness, apathy, and emergence of frailty in advancing PD, especially in the setting of medical comorbidities, are perhaps the biggest threats to experience sustained benefits with any of the available therapeutic options and therefore need to be aggressively treated as early as possible. Multimodal or combination therapies may provide complementary benefits to manage axial motor features in PD, but selection of treatment modalities should be tailored to the individual patient's needs.
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Affiliation(s)
- Martijn L T M Müller
- Functional Neuroimaging, Cognitive and Mobility Laboratory, Department of Radiology, University of Michigan, Ann Arbor, MI, USA.,Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, MI, USA
| | - Uros Marusic
- Institute for Kinesiology Research, Science and Research Centre of Koper, Koper, Slovenia.,Department of Health Sciences, Alma Mater Europaea - ECM, Maribor, Slovenia
| | - Miriam van Emde Boas
- Functional Neuroimaging, Cognitive and Mobility Laboratory, Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Daniel Weiss
- Centre for Neurology, Department for Neurodegenerative Diseases and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Nicolaas I Bohnen
- Functional Neuroimaging, Cognitive and Mobility Laboratory, Department of Radiology, University of Michigan, Ann Arbor, MI, USA.,Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, MI, USA.,Geriatric Research Education and Clinical Center, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Department of Neurology, University of Michigan, Ann Arbor, USA
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23
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Lee HK, Ahn SJ, Shin YM, Kang N, Cauraugh JH. Does transcranial direct current stimulation improve functional locomotion in people with Parkinson's disease? A systematic review and meta-analysis. J Neuroeng Rehabil 2019; 16:84. [PMID: 31286974 PMCID: PMC6615099 DOI: 10.1186/s12984-019-0562-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 06/28/2019] [Indexed: 12/22/2022] Open
Abstract
PURPOSE The purpose of this meta-analysis was to investigate the treatment effects of transcranial direct current stimulation (tDCS) on functional locomotion in people with Parkinson's disease (PD). METHODS A systematic literature search identified 18 qualified studies that used tDCS protocols as functional locomotion rehabilitation interventions for people with PD. All included studies used either a randomized control trial or crossover designs with a sham control group. Meta-analysis quantified both (a) short-term treatment effects: change in functional locomotion between baseline and immediate posttests on 18 comparisons and (b) long-term treatment effects: change in functional locomotion between baseline and delayed retention tests on six comparisons. Moreover, we performed moderator variable analyses for comparing effect sizes between tDCS targeting multiple brain regions and tDCS targeting a single brain region. RESULTS Random effects model meta-analyses revealed a significant short-term treatment effect (effect size = 0.359; P = 0.001), whereas no significant long-term treatment effects were identified (effect size = 0.164; P = 0.314). In addition, tDCS protocols that targeted multiple brain regions showed relatively more positive effects on functional locomotion than protocols that targeted a single brain region. CONCLUSIONS These meta-analytic findings indicate that tDCS protocols may show immediate positive effects on functional locomotion in people with PD. However, given the relatively low effect size, exploring more appropriate tDCS protocols (i.e., targeting multiple motor and prefrontal regions and medication condition) should be a focus in future studies.
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Affiliation(s)
- Hyo Keun Lee
- Division of Sport Science, Neuromechanical Rehabilitation Research Laboratory, Incheon National University, 119 Academy-ro, Yeonsu-gu, Incheon, South Korea
- Vector Biomechanics Inc., Yongin, South Korea
| | - Se Ji Ahn
- Division of Sport Science, Neuromechanical Rehabilitation Research Laboratory, Incheon National University, 119 Academy-ro, Yeonsu-gu, Incheon, South Korea
| | - Yang Mi Shin
- Division of Sport Science, Neuromechanical Rehabilitation Research Laboratory, Incheon National University, 119 Academy-ro, Yeonsu-gu, Incheon, South Korea
| | - Nyeonju Kang
- Division of Sport Science, Neuromechanical Rehabilitation Research Laboratory, Incheon National University, 119 Academy-ro, Yeonsu-gu, Incheon, South Korea
- Sport Science Institute, Incheon National University, Incheon, South Korea
| | - James H. Cauraugh
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida USA
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24
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Mapping the experiences and needs of deep brain stimulation for people with Parkinson’s disease and their family members. BRAIN IMPAIR 2019. [DOI: 10.1017/brimp.2019.3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractBackgroundDeep brain stimulation (DBS) is an effective treatment for the motor symptoms of Parkinson’s disease (PD). The lived experience of people with PD suggests a process of adjustment follows. This study aimed to explore the adjustment and associated education and support needs of people with PD undergoing DBS and their family members across the continuum of the DBS experience.MethodA structured qualitative description study including semi-structured interviews with people with PD (n = 14), family members (n = 10) and clinicians (n = 11) was conducted to explore lived experiences, needs, perspectives and clinical considerations. Inductive analysis indicated common temporal stages related to undergoing DBS, and the related experiences and needs were mapped.FindingsFour stages, each with unique needs, emerged: Considering DBS involved needs for peer-based education and realistic, meaningful goal setting; Surgery and Support shifted to clinical support related to the surgery and support for the person and their family around immediate changes experienced; Seeking Stability focused on timely clinical and practical support for the person and family around new changes and challenges to symptoms, behaviours and roles; and Next Steps involved direction and support for reengagement in the self-management of the condition, and current and future changes related to PD.All participants with PD and their family members in this study indicated that overall their experiences with DBS had led to positive changes in their symptoms and lives. Consideration of different needs at different times in the process may be applied within clinical practice to support adjustment.
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25
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Raffegeau TE, Krehbiel LM, Kang N, Thijs FJ, Altmann LJP, Cauraugh JH, Hass CJ. A meta-analysis: Parkinson's disease and dual-task walking. Parkinsonism Relat Disord 2018; 62:28-35. [PMID: 30594454 DOI: 10.1016/j.parkreldis.2018.12.012] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 10/24/2018] [Accepted: 12/11/2018] [Indexed: 01/14/2023]
Abstract
A growing body of literature has reported the effects of dual tasks on gait performance in people with Parkinson's disease (PD). The purpose of this meta-analysis was to synthesize the existing literature and quantify the overall influence of dual tasks on gait performance in PD. A thorough literature search was conducted, and 19 studies met the stringent inclusion criteria. Two moderator variable analyses examined the dual-task effect by: (a) mean single-task gait speed for each study (≥1.1 m/s or < 1.1 m/s), and (b) the type of dual task (arithmetic, language, memory, and motor). Three main findings were revealed by a random effects model analysis. First, a strong negative effect of dual tasks on walking performance (SMD = -0.68) confirmed that gait performance is adversely affected by dual tasks in people with PD. Second, the significant negative effect of dual tasks is present regardless of the mean level of single-task gait speed in a study. Third, dual-task walking speed deteriorates regardless of the type of dual task. Together, these results confirm that dual tasks severely affect walking performances in people with PD.
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Affiliation(s)
- Tiphanie E Raffegeau
- Applied Physiology and Kinesiology Department, University of Florida, Gainesville, FL, USA
| | - Lisa M Krehbiel
- Applied Physiology and Kinesiology Department, University of Florida, Gainesville, FL, USA
| | - Nyeonju Kang
- Applied Physiology and Kinesiology Department, University of Florida, Gainesville, FL, USA; Division of Sport Science & Sport Science Institute, Incheon National University, Seoul, South Korea
| | - Frency J Thijs
- Applied Physiology and Kinesiology Department, University of Florida, Gainesville, FL, USA
| | - Lori J P Altmann
- Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, FL, USA
| | - James H Cauraugh
- Applied Physiology and Kinesiology Department, University of Florida, Gainesville, FL, USA
| | - Chris J Hass
- Applied Physiology and Kinesiology Department, University of Florida, Gainesville, FL, USA.
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26
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Messripour M, Gheisary MM, Mesripour A. Age Related Effects of Levodopa on Rat Brain Striatal Acetylcholinesterase. NEUROCHEM J+ 2018. [DOI: 10.1134/s1819712418010105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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27
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Neuromodulatory procedures for gait disorders in Parkinson's disease. Acta Neurol Belg 2018; 118:13-19. [PMID: 29139079 DOI: 10.1007/s13760-017-0862-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 11/08/2017] [Indexed: 01/25/2023]
Abstract
The neurophysiology of gait is complex and involves numerous structures in the central nervous system. Gait disorders occur frequently in Parkinson's disease (PD), and their management may become cumbersome, especially in the more advanced stages. Neuromodulatory treatments, including deep brain stimulation, cortical stimulation and spinal cord stimulation, are reviewed with respect to their effectiveness to improve gait in PD patients. Although positive effects have been reported for all of these procedures, many issues remain in view of methodological heterogeneity, variability in outcome measures and sample size. Gait in PD remains a difficult issue with a tremendous impact on quality of life, for which future research is badly needed.
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28
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Scholten M, Klemt J, Heilbronn M, Plewnia C, Bloem BR, Bunjes F, Krüger R, Gharabaghi A, Weiss D. Effects of Subthalamic and Nigral Stimulation on Gait Kinematics in Parkinson's Disease. Front Neurol 2017; 8:543. [PMID: 29089922 PMCID: PMC5650991 DOI: 10.3389/fneur.2017.00543] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 09/27/2017] [Indexed: 01/24/2023] Open
Abstract
Conventional subthalamic deep brain stimulation for Parkinson's disease (PD) presumably modulates the spatial component of gait. However, temporal dysregulation of gait is one of the factors that is tightly associated with freezing of gait (FOG). Temporal locomotor integration may be modulated differentially at distinct levels of the basal ganglia. Owing to its specific descending brainstem projections, stimulation of the substantia nigra pars reticulata (SNr) area might modulate spatial and temporal parameters of gait differentially compared to standard subthalamic nucleus (STN) stimulation. Here, we aimed to characterize the differential effect of STN or SNr stimulation on kinematic gait parameters. We analyzed biomechanical parameters during unconstrained over ground walking in 12 PD patients with subthalamic deep brain stimulation and FOG. Patients performed walking in three therapeutic conditions: (i) Off stimulation, (ii) STN stimulation (alone), and (iii) SNr stimulation (alone). SNr stimulation was achieved by stimulating the most caudal contact of the electrode. We recorded gait using three sensors (each containing a tri-axial accelerometer, gyroscope, and magnetometer) attached on both left and right ankle, and to the lumbar spine. STN stimulation improved both the spatial features (stride length, stride length variability) and the temporal parameters of gait. SNr stimulation improved temporal parameters of gait (swing time asymmetry). Correlation analysis suggested that patients with more medial localization of the SNr contact associated with a stronger regularization of gait. These results suggest that SNr stimulation might support temporal regularization of gait integration.
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Affiliation(s)
- Marlieke Scholten
- Department of Neurodegenerative Diseases and Hertie Institute for Clinical Brain Research (HIH), University of Tuebingen, Tuebingen, Germany.,German Centre of Neurodegenerative Diseases (DZNE), University of Tuebingen, Tuebingen, Germany.,Centre for Integrative Neuroscience (CIN), University of Tuebingen, Tuebingen, Germany.,Graduate School of Neural & Behavioural Sciences, International Max Planck Research School, University of Tuebingen, Tuebingen, Germany
| | - Johannes Klemt
- Department of Neurodegenerative Diseases and Hertie Institute for Clinical Brain Research (HIH), University of Tuebingen, Tuebingen, Germany.,German Centre of Neurodegenerative Diseases (DZNE), University of Tuebingen, Tuebingen, Germany.,Centre for Integrative Neuroscience (CIN), University of Tuebingen, Tuebingen, Germany
| | - Melanie Heilbronn
- Department of Neurodegenerative Diseases and Hertie Institute for Clinical Brain Research (HIH), University of Tuebingen, Tuebingen, Germany.,German Centre of Neurodegenerative Diseases (DZNE), University of Tuebingen, Tuebingen, Germany.,Centre for Integrative Neuroscience (CIN), University of Tuebingen, Tuebingen, Germany
| | - Christian Plewnia
- Centre for Integrative Neuroscience (CIN), University of Tuebingen, Tuebingen, Germany.,Department of Psychiatry and Psychotherapy, University of Tuebingen, Tuebingen, Germany
| | - Bastiaan R Bloem
- Radboud University Medical Centre, Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Nijmegen, Netherlands
| | - Friedemann Bunjes
- Department of Neurodegenerative Diseases and Hertie Institute for Clinical Brain Research (HIH), University of Tuebingen, Tuebingen, Germany
| | - Rejko Krüger
- Department of Neurodegenerative Diseases and Hertie Institute for Clinical Brain Research (HIH), University of Tuebingen, Tuebingen, Germany.,German Centre of Neurodegenerative Diseases (DZNE), University of Tuebingen, Tuebingen, Germany.,Centre for Integrative Neuroscience (CIN), University of Tuebingen, Tuebingen, Germany.,Clinical and Experimental Neuroscience, Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg Center Hospitalier de Luxembourg (CHL), Luxembourg, Luxembourg
| | - Alireza Gharabaghi
- Centre for Integrative Neuroscience (CIN), University of Tuebingen, Tuebingen, Germany.,Division of Functional and Restorative Neurosurgery, Department of Neurosurgery, University of Tuebingen, Tuebingen, Germany
| | - Daniel Weiss
- Department of Neurodegenerative Diseases and Hertie Institute for Clinical Brain Research (HIH), University of Tuebingen, Tuebingen, Germany.,German Centre of Neurodegenerative Diseases (DZNE), University of Tuebingen, Tuebingen, Germany.,Centre for Integrative Neuroscience (CIN), University of Tuebingen, Tuebingen, Germany
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29
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Kim G, Kim KS, Lee S. The integration of neural information by a passive kinetic stimulus and galvanic vestibular stimulation in the lateral vestibular nucleus. Med Biol Eng Comput 2017; 55:1621-1633. [PMID: 28176264 DOI: 10.1007/s11517-017-1618-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 01/25/2017] [Indexed: 02/07/2023]
Abstract
Despite an easy control and the direct effects on vestibular neurons, the clinical applications of galvanic vestibular stimulation (GVS) have been restricted because of its unclear activities as input. On the other hand, some critical conclusions have been made in the peripheral and the central processing of neural information by kinetic stimuli with different motion frequencies. Nevertheless, it is still elusive how the neural responses to simultaneous GVS and kinetic stimulus are modified during transmission and integration at the central vestibular area. To understand how the neural information was transmitted and integrated, we examined the neuronal responses to GVS, kinetic stimulus, and their combined stimulus in the vestibular nucleus. The neuronal response to each stimulus was recorded, and its responding features (amplitude and baseline) were extracted by applying the curve fitting based on a sinusoidal function. Twenty-five (96.2%) comparisons of the amplitudes showed that the amplitudes decreased during the combined stimulus (p < 0.001). However, the relations in the amplitudes (slope = 0.712) and the baselines (slope = 0.747) were linear. The neuronal effects by the different stimuli were separately estimated; the changes of the amplitudes were mainly caused by the kinetic stimulus and those of the baselines were largely influenced by GVS. Therefore, the slopes in the comparisons implied the neural sensitivity to the applied stimuli. Using the slopes, we found that the reduced amounts of the neural information were transmitted. Overall, the comparisons of the responding features demonstrated the linearity and the subadditivity in the neural transmission.
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Affiliation(s)
- Gyutae Kim
- Institute for Information and Electronics Research, Inha University, High-Tech Center #716, 100 Inharo, Namgu, Incheon, 402-751, Republic of Korea.
| | - Kyu-Sung Kim
- Institute for Information and Electronics Research, Inha University, High-Tech Center #716, 100 Inharo, Namgu, Incheon, 402-751, Republic of Korea.,Department of Otolaryngology, School of Medicine, Inha University, 27 Inhang-ro, Jung-Gu, Incheon, 400-711, Republic of Korea
| | - Sangmin Lee
- Institute for Information and Electronics Research, Inha University, High-Tech Center #716, 100 Inharo, Namgu, Incheon, 402-751, Republic of Korea.,School of Electronic/Electrical Engineering, Inha University, High-Tech Center #704, 100 Inharo, Namgu, Incheon, 402-751, Republic of Korea
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30
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Therapies for Parkinson’s diseases: alternatives to current pharmacological interventions. J Neural Transm (Vienna) 2016; 123:1279-1299. [DOI: 10.1007/s00702-016-1603-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 07/25/2016] [Indexed: 12/12/2022]
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