Effect of subthalamic deep brain stimulation on gait in patients with advanced Parkinson’s disease

Abstract

Introduction: Advanced Parkinson's disease severely affects gait. According to literature, deep brain stimulation of the subthalamic nucleus has scarce impact on gait in this disease. Objective: To evaluate and compare gait kinematics and parameters in patients with Advanced Parkinson's disease treated previously with deep brain stimulation of the subthalamic nucleus without anti-Parkinsonian medications, in ON and OFF modes of stimulation. Methodology: This was a single-group pre-post quasi-experimental study and included 11 patients with idiopathic Advanced Parkinson's disease who were treated with deep brain stimulation of the subthalamic nucleus. Gait kinematic measurements were compared between the ON-OFF conditions within the same patients. Results: A significantly greater range of joint movement was found in the ON condition vs. OFF condition in the knee (42.64° vs. 38.28°, p=0.04) and the ankle (20.42° vs. 16.58°, p=0.04). In the coronal plane, greater joint movement was found in the trunk (4.0° vs. 3.19°, p=0.05). Gait Deviation Index was significantly higher while in ON condition vs. OFF condition (80.23° vs. 75.15°, p=0.06). Discussion: Although this study yields data that supports the fact that the deep brain stimulation of the subthalamic nucleus positively affects the gait characteristics studied and presented, there are others that have reported contradictory findings, possibly related to methodological limitations. Conclusions: Patients presented an improvement in gait kinematics and parameters with the effects of deep brain stimulation of the subthalamic nucleus. Gait Deviation Index was sensitive to changes observed under ON-OFF conditions. Studies with larger number of patients are needed to draw more accurate conclusions.

Keywords

• Deep brain stimulation
• Parkinson’s disease
• Gait analysis
• kinematics