Effects of subthalamic nucleus stimulation and levodopa treatment on gait abnormalities in Parkinson disease.
BACKGROUND
Stimulation of the subthalamic nucleus is proposed for the treatment of patients presenting with severe Parkinson disease. The effect on gait is not clearly established.


OBJECTIVE
To evaluate objectively the influence of bilateral subthalamic nucleus stimulation on gait in Parkinson disease and to compare it with the effects of levodopa treatment.


METHODS
Ten patients underwent bilateral subthalamic nucleus stimulation. The preoperative and postoperative (3 months after surgery) clinical gait disturbances, as well as spatial and temporal gait parameters, were analyzed in off and on-drug conditions. The gait analysis was performed using a video motion analysis system (optoelectronic VICON system; Oxford Metrics, Oxford, England).


RESULTS
In the off condition, there was an improvement after surgery for the total motor score and the gait subscore. In the on-drug condition, there was an improvement in levodopa-induced dyskinesias and the motor score, whereas the gait subscore was unchanged. For the gait parameters measured by the video motion analysis system system, there was also an improvement in the off condition and to a lesser extent in the on-drug condition.


CONCLUSIONS
Our method allowed exact quantification of the benefit of surgery on gait parameters. Compared with the levodopa treatment, the effect of stimulation on gait kinematic parameters seems to be qualitatively similar but quantitatively different with a lower benefit on gait velocity and stride length. Concerning the pathophysiology of gait troubles in Parkinson disease, the deficit in control of stride length would be the fundamental deficit. The study underlines the possible role of the subthalamic nucleus on the stride length regulation.
Krystkowiak
Pierre
P
Department of Gait Analysis, Centre Hospitalier et Universitaire de Lille, France. p-krystkowiak@chru-lille.fr
Blatt
Jean-Louis
JL
Bourriez
Jean-Louis
JL
Duhamel
Alain
A
Perina
Miriam
M
Blond
Serge
S
Guieu
Jean-Daniel
JD
Destée
Alain
A
Defebvre
Luc
L
D000978:Antiparkinson Agents / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D004599:Electric Stimulation Therapy; D005260:Female; D020233:Gait Disorders, Neurologic / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D007980:Levodopa / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications / Q000188:drug therapy*; D020531:Subthalamic Nucleus / Q000502:physiology*; D016896:Treatment Outcome
D000978:Antiparkinson Agents; D007980:Levodopa