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Deep Brain Stimulation in Parkinson’s Disease: Effects on Gait and Postural Control

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Locomotion and Posture in Older Adults

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Abstract

Patients with Parkinson’s disease (PD) commonly suffer from gait and postural disorders (Bloem et al., Mov Disord 19:871–84, 2004), often leading to falls and injuries (Segev-Jacubovski et al., Expert Rev Neurother 11:1057–75, 2011; Montero-Odasso et al., J Am Geriatr Soc 60:2127–36, 2012). When the symptoms of the disease become resistant to drugs, a routine neurosurgical treatment is implantation of electrodes for deep brain stimulation (DBS). Whereas DBS is most effective in alleviating the symptoms of tremor and rigidity, it has also been demonstrated to reduce gait variability, thus improving stability (Hausdorff et al., Mov Disord Off J Mov Disord Soc 24:1688–92, 2009). We therefore begin by reviewing the effect of DBS on gait and posture when electrodes are implanted in the most common targets: the subthalamic nucleus (STN) and the globus pallidus internum (GPi) and with the commonly used high frequency parameters (around 130 Hz), considering the possible mechanisms underlying its therapeutic effect, negative effects, and the deterioration in therapeutic effect over time. We continue by examining a recently suggested change of parameters, reduction of stimulation frequency to 60 or 80 Hz, in order to specifically treat gait impairment. Another phenomenon that has been addressed by DBS in recent year is freezing of gait, which is a particularly debilitating phenomenon experienced by a subpopulation of patients with PD. To alleviate freezing, the pedunculopontine nucleus (PPN) has been suggested as the target brain area. Mixed evidence as for the effectiveness of this treatment and the exact symptoms it affects imply that more studies are necessary in order to establish PPN DBS as a routine treatment. We conclude with a brief summary of open questions and work that should be addressed in future studies.

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Abbreviations

DBS:

Deep brain stimulation

fMRI:

Functional magnetic resonance imaging

GPi:

Globus pallidus internum

PD:

Parkinson’s disease

PIGD:

Postural instability and gait disturbances

PPN:

Pedunculopontine nucleus

STN:

Subthalamic nucleus

UPDRS:

Unified Parkinson’s disease rating scale

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Authors and Affiliations

  1. Center for Study of Movement, Cognition and Mobility, Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel

    Ariel Tankus & Jeffrey M. Hausdorff

  2. Functional Neurosurgery Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel

    Ariel Tankus

  3. Department of Neurology and Neurosurgery, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Ariel Tankus

  4. Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel

    Ariel Tankus & Jeffrey M. Hausdorff

  5. Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Jeffrey M. Hausdorff

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  1. Ariel Tankus
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Correspondence to Ariel Tankus .

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Editors and Affiliations

  1. Universidade Estadual Paulista (Unesp), Department of Physical Education, Human Movement Research Laboratory – MOVI-LAB, Campus Bauru, São Paulo, Brazil

    Fabio Augusto Barbieri

  2. Universidade Estadual Paulista (Unesp), Department of Physical Education, Posture and Gait Studies Lab (LEPLO), Campus Rio Claro, São Paulo, Brazil

    Rodrigo Vitório

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Tankus, A., Hausdorff, J.M. (2017). Deep Brain Stimulation in Parkinson’s Disease: Effects on Gait and Postural Control. In: Barbieri, F., Vitório, R. (eds) Locomotion and Posture in Older Adults. Springer, Cham. https://doi.org/10.1007/978-3-319-48980-3_24

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