title: Postural stability under globus pallidus internus stimulation for dystonia.
abstract: OBJECTIVE
  Deep brain stimulation of the globus pallidus internus (GPi-DBS) is an efficient and safe treatment for medically refractory dystonia. However, recent studies reported gait problems, falls and bradykinesia in patients after the DBS procedure. The aim of this study was to quantify the effect of GPi-DBS on postural performance in patients with cranio-cervical dystonia.
  
  
  METHODS
  Thirteen patients with focal/segmental dystonia and GPi-DBS participated in the study. We performed two postural tests (pull test and push and release test) in on- and off-stimulation conditions and recorded the movements of the patients with inertial sensors.
  
  
  RESULTS
  Under stimulation patients exhibited a higher number of steps (p=0.015), reduced first step length (p=0.011) and lower stepping velocity (p=0.001), compared to off stimulation. We observed a higher number of steps in the push and release test compared to the pull test (p=0.038). The interaction between stimulation condition and test type was significant (p=0.027).
  
  
  CONCLUSIONS
  The velocity and amplitude of postural reactions are compromised by GPi-DBS in patients with cranio-cervical dystonia.
  
  
  CONCLUSIONS
  This information corresponds to patient's reports of falls and postural instability after GPi-DBS. Pre-operatively, patients should be informed about the possibility of the occurrence of such phenomena.
authors.affiliation: Department of Neurology, Ludwig-Maximilian University, Munich, Germany; Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia.
authors.forename: Gregor
authors.initials: G
authors.lastname: Brecl Jakob
authors.affiliation: Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, Ludwig-Maximilian University, Munich, Germany.
authors.forename: Olena
authors.initials: O
authors.lastname: Pelykh
authors.affiliation: Department of Neurology, Ludwig-Maximilian University, Munich, Germany; 2nd Department of Neurology, School of Medicine, Comenius University, Bratislava, Slovak Republic.
authors.forename: Zuzana
authors.initials: Z
authors.lastname: Košutzká
authors.affiliation: Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia.
authors.forename: Zvezdan
authors.initials: Z
authors.lastname: Pirtošek
authors.affiliation: Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia.
authors.forename: Maja
authors.initials: M
authors.lastname: Trošt
authors.affiliation: Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, Ludwig-Maximilian University, Munich, Germany.
authors.forename: Joseph
authors.initials: J
authors.lastname: Ilmberger
authors.affiliation: 2nd Department of Neurology, School of Medicine, Comenius University, Bratislava, Slovak Republic; Laboratory of Motor Control, Institute of Normal and Pathological Physiology, Slovak Academy of Sciences, Bratislava, Slovak Republic.
authors.forename: Peter
authors.initials: P
authors.lastname: Valkovic
authors.affiliation: Department of Neurosurgery, Ludwig-Maximilian University, Munich, Germany.
authors.forename: Jan H
authors.initials: JH
authors.lastname: Mehrkens
authors.affiliation: Department of Neurology, Ludwig-Maximilian University, Munich, Germany. Electronic address: kboetzel@med.uni-muenchen.de.
authors.forename: Kai
authors.initials: K
authors.lastname: Bötzel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D046690:Deep Brain Stimulation / Q000379:methods*; D020821:Dystonic Disorders / Q000175:diagnosis* / Q000628:therapy*; D005260:Female; D005917:Globus Pallidus / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D004856:Postural Balance / Q000502:physiology*; D011187:Posture / Q000502:physiology*; D016896:Treatment Outcome
keywords: Deep brain stimulation; Dystonia; Globus pallidus; Postural balance