Evolution of postural stability after subthalamic nucleus stimulation in Parkinson's disease: a combined clinical and posturometric study.
OBJECTIVE
The occurrence of postural and balance disorders is a frequent feature in advanced forms of Parkinson's disease (PD). However, the pathological substrate of these disturbances is poorly understood.


METHODS
In the present work, we investigated the evolution of posturometric parameters [center of pressure (CoP) displacement and CoP area] and axial scores between the pre-operative period and 3 months post-operative in seven PD patients who underwent bilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN).


RESULTS
After surgery, the patients leaned backwards much more regardless of the STN stimulation, suggesting that surgery could have a deleterious effect on postural adaptation. During the post-operative period, the improvement in axial and postural scores was similar under levodopatherapy and DBS. On the other hand, DBS of the STN significantly reduced the CoP displacement and the CoP area, whereas levodopatherapy tended only to reduce the CoP displacement and to increase the CoP area significantly.


CONCLUSIONS
These data suggest that DBS of the STN and levodopa do not act on the same neurological systems involved in posture regulation. DBS of the STN could improve posture via a direct effect on the pedunculopontine nucleus, which is known to be involved in posture regulation.
Guehl
D
D
Service de Neurophysiologie Clinique, Hôpital Pellegrin, Place Amélie-Raba-Léon, CNRS UMR 5543, Université de Bordeaux, 2, Victor Segalen, 146 rue Léo Saignat, 33076, Bordeaux, France. dominique.guehl@umr5543.u-bordeaux2.fr
Dehail
P
P
de Sèze
M P
MP
Cuny
E
E
Faux
P
P
Tison
F
F
Barat
M
M
Bioulac
B
B
Burbaud
P
P
D000328:Adult; D000368:Aged; D000978:Antiparkinson Agents / Q000494:pharmacology; D004599:Electric Stimulation Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D007980:Levodopa / Q000494:pharmacology; D008297:Male; D008875:Middle Aged; D009119:Muscle Contraction / Q000502:physiology; D018482:Muscle, Skeletal / Q000294:innervation / Q000503:physiopathology*; D009434:Neural Pathways / Q000187:drug effects / Q000502:physiology; D010300:Parkinson Disease / Q000628:therapy*; D045042:Pedunculopontine Tegmental Nucleus / Q000502:physiology; D004856:Postural Balance / Q000502:physiology*; D020531:Subthalamic Nucleus / Q000502:physiology*; D016896:Treatment Outcome
D000978:Antiparkinson Agents; D007980:Levodopa