Anticipatory Postural Adjustments and Compensatory Postural Responses to Multidirectional Perturbations—Effects of Medication and Subthalamic Nucleus Deep Brain Stimulation in Parkinson’s Disease

Abstract

Background: Postural instability is one of the most restricting motor symptoms for patients with Parkinson’s disease (PD). While medication therapy only shows minor effects, it is still unclear whether medication in conjunction with deep brain stimulation (DBS) of the subthalamic nucleus (STN) improves postural stability. Hence, the aim of this study was to investigate whether PD patients treated with medication in conjunction with STN-DBS have superior postural control compared to patients treated with medication alone. Methods: Three study groups were tested: PD patients on medication (PD-MED), PD patients on medication and on STN-DBS (PD-MED–DBS), and healthy elderly subjects (HS) as a reference. Postural performance, including anticipatory postural adjustments (APA) prior to perturbation onset and compensatory postural responses (CPR) following multidirectional horizontal perturbations, was analyzed using force plate and electromyography data. Results: Regardless of the treatment condition, both patient groups showed inadequate APA and CPR with early and pronounced antagonistic muscle co-contractions compared to healthy elderly subjects. Comparing the treatment conditions, study group PD-MED–DBS only showed minor advantages over group PD-MED. In particular, group PD-MED–DBS showed faster postural reflexes and tended to have more physiological co-contraction ratios. Conclusion: medication in conjunction with STN-DBS may have positive effects on the timing and amplitude of postural control.

Keywords

• Parkinson’s disease
• deep brain stimulation
• subthalamic nucleus
• postural instability
• motor control
• anticipatory postural adjustments