Subthalamic nucleus stimulation and levodopa-resistant postural instability in Parkinson's disease

We examined the effect of bilateral subthalamic nucleus stimulation on levodopa-resistant balance impairment in 14 patients with Parkinson's disease and 18 matched controls. Instability was quantitatively assessed using standardized multidirectional dynamic posturography. Patients were tested after taking a suprathreshold dose of levodopa, both with stimulators turned on and off. Patients with stimulators turned off were more unstable than controls following backward directed perturbations. Overall, patients' instability did not improve with STN stimulation, and considerable inter-individual variability was noted. Of note, marked levodopa- resistant axial motor symptoms before surgery correlated with an adverse treatment effect. We conclude that STN stimulation does not alleviate levodopa-resistant postural instability in Parkinson's disease.

[1]  P. Stanzione,et al.  Implantation of human pedunculopontine nucleus: a safe and clinically relevant target in Parkinson's disease , 2005, Neuroreport.

[2]  Y. Agid,et al.  Axial parkinsonian symptoms can be improved: the role of levodopa and bilateral subthalamic stimulation , 2000, Journal of neurology, neurosurgery, and psychiatry.

[3]  L. Maillard,et al.  Bilateral subthalamic nucleus stimulation improves balance control in Parkinson’s disease , 2005, Journal of Neurology, Neurosurgery & Psychiatry.

[4]  J. Hughes,et al.  Accuracy of clinical diagnosis of idiopathic Parkinson's disease: a clinico-pathological study of 100 cases. , 1992, Journal of neurology, neurosurgery, and psychiatry.

[5]  D. Winter,et al.  Motor mechanisms of balance during quiet standing. , 2003, Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology.

[6]  A. Lang,et al.  Utility of an objective dyskinesia rating scale for Parkinson's disease: Inter‐ and intrarater reliability assessment , 1994, Movement disorders : official journal of the Movement Disorder Society.

[7]  A. Thorstensson,et al.  Deceleration affects anticipatory and reactive components of triggered postural responses , 2005, Experimental Brain Research.

[8]  R. D. de Haan,et al.  Unilateral pallidotomy versus bilateral subthalamic nucleus stimulation in PD , 2004, Neurology.

[9]  S. Gill,et al.  Bilateral deep brain stimulation of the pedunculopontine nucleus for Parkinson's disease , 2005, Neuroreport.

[10]  F Honegger,et al.  Postural abnormalities to multidirectional stance perturbations in Parkinson’s disease , 2004, Journal of Neurology, Neurosurgery & Psychiatry.

[11]  Lucy Yardley,et al.  Clinical Disorders of Balance, Posture and Gait , 1996 .

[12]  John H. J. Allum,et al.  Chapter 20 Posturography , 2003 .

[13]  S Fahn,et al.  Evaluation of the pull test technique in assessing postural instability in Parkinson’s disease , 2004, Neurology.

[14]  Y. Agid,et al.  Clinical predictive factors of subthalamic stimulation in Parkinson's disease. , 2002, Brain : a journal of neurology.

[15]  A. Benabid,et al.  Five-year follow-up of bilateral stimulation of the subthalamic nucleus in advanced Parkinson's disease. , 2003, The New England journal of medicine.

[16]  Gait and balance in basal ganglia disorders , 2004 .

[17]  A. Benabid,et al.  Predictors of effective bilateral subthalamic nucleus stimulation for PD , 2002, Neurology.

[18]  Marten Munneke,et al.  Effects of stereotactic neurosurgery on postural instability and gait in Parkinson's disease , 2004, Movement disorders : official journal of the Movement Disorder Society.

[19]  P. Krack,et al.  Deep-brain stimulation of the subthalamic nucleus or the pars interna of the globus pallidus in Parkinson's disease. , 2001, The New England journal of medicine.

[20]  J. Allum,et al.  Age‐dependent variations in the directional sensitivity of balance corrections and compensatory arm movements in man , 2002, The Journal of physiology.

[21]  A. Benabid,et al.  Electrical stimulation of the subthalamic nucleus in advanced Parkinson's disease. , 1998, The New England journal of medicine.

[22]  J. Allum,et al.  Effect of bilateral subthalamic nucleus stimulation on balance and finger control in Parkinson's disease , 2005, Journal of Neurology.

[23]  V Sturm,et al.  Bilateral high‐frequency stimulation of the internal globus pallidus in advanced Parkinson's disease , 1998, Annals of neurology.

[24]  A L Benabid,et al.  Subthalamic nucleus or internal pallidal stimulation in young onset Parkinson's disease. , 1998, Brain : a journal of neurology.

[25]  F. Horak,et al.  Direction-specific postural instability in subjects with Parkinson's disease , 2005, Experimental Neurology.

[26]  F. Horak,et al.  Comparison between subthalamic nucleus and globus pallidus internus stimulation for postural performance in Parkinson's disease. , 2004, Gait & posture.

[27]  B. Bloem,et al.  Role of the Basal Ganglia in Balance Control , 2005, Neural plasticity.

[28]  C H Lücking,et al.  Effect of chronic bilateral subthalamic nucleus (STN) stimulation on postural control in Parkinson's disease. , 2003, Brain : a journal of neurology.