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Effects of deep brain stimulation on balance and gait in patients with Parkinson's disease: A systematic neurophysiological review.
Neurophysiol Clin. 2015 Nov; 45(4-5):371-88.NC

Abstract

Deep brain stimulation (DBS) of the subthalamic nucleus (STN) and internal globus pallidus (GPi) deep brain stimulation (DBS) provides an efficient treatment for the alleviation of motor signs in patients with Parkinson's disease. The effects of DBS on gait and balance disorders are less successful and may even lead to an aggravation of freezing of gait and imbalance. The identification of a substantia nigra pars reticulata (SNr)-mesencephalic locomotor region (MLR) network in the control of locomotion and postural control and of its dysfunction/lesion in PD patients with gait and balance disorders led to suggestion that DBS should be targeting the SNr and the pedunculopontine nucleus (part of the MLR) for PD patients with these disabling axial motor signs. However, the clinical results to date have been disappointing. In this review, we discuss the effects of DBS of these basal ganglia and brainstem structures on the neurophysiological parameters of gait and balance control in PD patients. Overall, the data suggest that both STN and GPi-DBS improve gait parameters and quiet standing postural control in PD patients, but have no effect or may even aggravate dynamic postural control, in particular with STN-DBS. Conversely, DBS of the SNr and PPN has no effect on gait parameters but improves anticipatory postural adjustments and gait postural control.

Authors+Show Affiliations

AP-HP, hôpital de la Salpêtrière, département de neurologie, bâtiment Paul-Castaigne, groupe hospitalier de la Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France; Inserm, U1127, 75013 Paris, France; Sorbonne universités, UPMC université Paris 06, UMRS 1127, 75013 Paris, France; CNRS, UMR 7225, ICM, 75013 Paris, France; Institut du cerveau et de la moelle épinière, ICM, 75013 Paris, France.AP-HP, hôpital de la Salpêtrière, département de neurologie, bâtiment Paul-Castaigne, groupe hospitalier de la Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France; Inserm, U1127, 75013 Paris, France; Sorbonne universités, UPMC université Paris 06, UMRS 1127, 75013 Paris, France; CNRS, UMR 7225, ICM, 75013 Paris, France; Institut du cerveau et de la moelle épinière, ICM, 75013 Paris, France. Electronic address: marie-laure.welter@psl.aphp.fr.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

26319759

Citation

Collomb-Clerc, A, and M-L Welter. "Effects of Deep Brain Stimulation On Balance and Gait in Patients With Parkinson's Disease: a Systematic Neurophysiological Review." Neurophysiologie Clinique = Clinical Neurophysiology, vol. 45, no. 4-5, 2015, pp. 371-88.
Collomb-Clerc A, Welter ML. Effects of deep brain stimulation on balance and gait in patients with Parkinson's disease: A systematic neurophysiological review. Neurophysiol Clin. 2015;45(4-5):371-88.
Collomb-Clerc, A., & Welter, M. L. (2015). Effects of deep brain stimulation on balance and gait in patients with Parkinson's disease: A systematic neurophysiological review. Neurophysiologie Clinique = Clinical Neurophysiology, 45(4-5), 371-88. https://doi.org/10.1016/j.neucli.2015.07.001
Collomb-Clerc A, Welter ML. Effects of Deep Brain Stimulation On Balance and Gait in Patients With Parkinson's Disease: a Systematic Neurophysiological Review. Neurophysiol Clin. 2015;45(4-5):371-88. PubMed PMID: 26319759.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of deep brain stimulation on balance and gait in patients with Parkinson's disease: A systematic neurophysiological review. AU - Collomb-Clerc,A, AU - Welter,M-L, Y1 - 2015/08/28/ PY - 2015/05/10/received PY - 2015/06/23/revised PY - 2015/07/16/accepted PY - 2015/8/31/entrez PY - 2015/9/1/pubmed PY - 2016/9/15/medline KW - Balance KW - Deep brain stimulation KW - Gait KW - Maladie de Parkinson KW - Marche KW - Parkinson's disease KW - Posture KW - Stimulation cérébrale profonde KW - Équilibre SP - 371 EP - 88 JF - Neurophysiologie clinique = Clinical neurophysiology JO - Neurophysiol Clin VL - 45 IS - 4-5 N2 - Deep brain stimulation (DBS) of the subthalamic nucleus (STN) and internal globus pallidus (GPi) deep brain stimulation (DBS) provides an efficient treatment for the alleviation of motor signs in patients with Parkinson's disease. The effects of DBS on gait and balance disorders are less successful and may even lead to an aggravation of freezing of gait and imbalance. The identification of a substantia nigra pars reticulata (SNr)-mesencephalic locomotor region (MLR) network in the control of locomotion and postural control and of its dysfunction/lesion in PD patients with gait and balance disorders led to suggestion that DBS should be targeting the SNr and the pedunculopontine nucleus (part of the MLR) for PD patients with these disabling axial motor signs. However, the clinical results to date have been disappointing. In this review, we discuss the effects of DBS of these basal ganglia and brainstem structures on the neurophysiological parameters of gait and balance control in PD patients. Overall, the data suggest that both STN and GPi-DBS improve gait parameters and quiet standing postural control in PD patients, but have no effect or may even aggravate dynamic postural control, in particular with STN-DBS. Conversely, DBS of the SNr and PPN has no effect on gait parameters but improves anticipatory postural adjustments and gait postural control. SN - 1769-7131 UR - https://www.unboundmedicine.com/medline/citation/26319759/Effects_of_deep_brain_stimulation_on_balance_and_gait_in_patients_with_Parkinson's_disease:_A_systematic_neurophysiological_review_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0987-7053(15)00040-4 DB - PRIME DP - Unbound Medicine ER -