[Gait disorders in Parkinson's disease]

[The effect of bilateral subthalamic nucleus deep brain stimulation on gait and balance in patients with Parkinson's disease]

Deep stimulation of the subthalamic nucleus (DBS STN) is a highly effective and relatively safety method of surgical treatment of Parkinson's disease (PD), which can significantly reduce the motor symptoms of the disease (rigidity, tremor, hypokinesia), as well as levodopa-associated dyskinesia and fluctuations. However, the effect of DBS STN on axial symptoms, such as gait and postural stability, remains contentious. The searching for risk factors for worsening gait and balance disturbances in patients receiving DBS STN continues. Studies are being perfomed on the parameters of the DBS STN to reduce its negative impact on gait and balance.

[Chronic epidural spinal cord stimulation for gait impairments in Parkinson's disease and atypical parkinsonism]

Spinal cord stimulation is a well-established, minimally invasive surgical technique that has been effectively utilized for the treatment of chronic pain syndromes. In the past 15 years, there has been a significant increase in reports on the use of spinal stimulation for patients with advanced Parkinson's disease (PD), as well as in isolated cases of atypical parkinsonism. These reports frequently highlight a positive impact of spinal stimulation on gait impairments. A hallmark symptom of advanced PD, as well as several phenotypes of progressive supranuclear palsy, is the freezing of gait phenomenon. This condition, akin to postural instability, is likely linked to disruptions in multimodal integration across various levels of locomotor control. Given its poor responsiveness to dopaminergic therapy, freezing of gait remains one of the most debilitating symptoms in parkinsonism. This review consolidates current knowledge on the use of chronic epidural spinal cord stimulation in patients with PD and atypical parkinsonism, with a focus on its potential to alleviate locomotor disorders, particularly freezing of gait.

[The use of donepezil in gait disorders in eldery patients with dementia]

Donepezil is the most commonly used cholinesterase inhibitor. The indication for its use is Alzheimer's disease. A number of clinical studies have shown its effectiveness in vascular dementia, dementia with Lewy bodies, Parkinson's disease with dementia, dementia due to traumatic brain injury. It is shown that dementia is a risk factor for falls, and standard measures to prevent falls in the elderly are ineffective in patients with cognitive impairment. This article provides a review of publications on the influence of donepezil on gait and balance. Most authors agree that donepezil is able to improve some parameters of gait, such as gait velocity and stride time variability, which can increase stability and reduce the risk of falls. The effect of donepezil on motor function is small, but its use may be particularly valuable if other approaches to treatment of gait disorders in patients with cognitive impairment are ineffective.