Effect of subthalamic deep brain stimulation on postural abnormality in Parkinson disease.
OBJECTIVE
Parkinson disease (PD) is often accompanied by various postural abnormalities such as camptocormia (bent spine) or Pisa syndrome (lateral flexion). The authors studied the effect of subthalamic nucleus deep brain stimulation (STN DBS) on postural abnormality in patients with PD.


METHODS
The authors retrospectively reviewed the clinical course of 18 patients who suffered from significant postural abnormality and underwent bilateral STN DBS. Patients whose preoperative posture score (Unified Parkinson's Disease Rating Scale III, item 28) was 2 or more in the "medication-on" state were enrolled in this study. Eight patients were considered to have camptocormia, and 10 patients were considered to have so-called Pisa syndrome. Nine patients showed apparent thoracolumbar spinal deformity on radiography. Most patients had significant motor fluctuations from levodopa.


RESULTS
In 13 patients with moderate postural abnormality (score of 2 on item 28), 9 patients improved soon after surgery, but 1 patient relapsed. Two patients improved gradually over a long period after surgery, whereas 2 patients did not improve at all. In 5 patients with severe postural abnormality (score of 3 or 4 on item 28), 2 patients improved slightly in the long-term follow-up period after surgery, but 3 patients did not improve at all.


CONCLUSIONS
Postural abnormality in patients with PD could be ameliorated by STN DBS, and therefore surgery should be considered before irreversible spinal deformity develops.
Umemura
Atsushi
A
Department of Neurosurgery, Nagoya City University Medical School, Nagoya, Japan. aume@med.nagoya-cu.ac.jp
Oka
Yuichi
Y
Ohkita
Kenji
K
Yamawaki
Takemori
T
Yamada
Kazuo
K
D000368:Aged; D000978:Antiparkinson Agents / Q000009:adverse effects / Q000627:therapeutic use; D046690:Deep Brain Stimulation / Q000379:methods*; D005260:Female; D006801:Humans; D007980:Levodopa / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D010300:Parkinson Disease / Q000503:physiopathology / Q000628:therapy*; D004856:Postural Balance / Q000502:physiology; D011187:Posture / Q000502:physiology*; D012008:Recurrence; D012189:Retrospective Studies; D020531:Subthalamic Nucleus / Q000503:physiopathology*
D000978:Antiparkinson Agents; D007980:Levodopa