Abstract
Objective
To assess the long-term effects of bilateral subthalamic nucleus deep brain stimulation (STN-DBS) on gait in a cohort of advanced Parkinson’s Disease (PD) patients.
Methods
This observational study included consecutive PD patients treated with bilateral STN-DBS. Different stimulation and drug treatment conditions were assessed: on-stimulation/off-medication, off-stimulation/off-medication, and on-stimulation/on-medication. Each patient performed the instrumented Timed Up and Go test (iTUG). The instrumental evaluation of walking ability was carried out with a wearable inertial sensor containing a three-dimensional (3D) accelerometer, gyroscope, and magnetometer. This device could provide 3D linear acceleration, angular velocity, and magnetic field vector. Disease motor severity was evaluated with the total score and subscores of the Unified Parkinson Disease Rating Scale part III.
Results
Twenty-five PD patients with a 5-years median follow-up after surgery (range 3–7) were included (18 men; mean disease duration at surgery 10.44 ± 4.62 years; mean age at surgery 58.40 ± 5.73 years). Both stimulation and medication reduced the total duration of the iTUG and most of its different phases, suggesting a long-term beneficial effect on gait after surgery. However, comparing the two treatments, dopaminergic therapy had a more marked effect in all test phases. STN-DBS alone reduced total iTUG duration, sit-to-stand, and second turn phases duration, while it had a lower effect on stand-to-sit, first turn, forward walking, and walking backward phases duration.
Conclusions
This study highlighted that in the long-term after surgery, STN-DBS may contribute to gait and postural control improvement when used together with dopamine replacement therapy, which still shows a substantial beneficial effect.
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Availability of data and material (data transparency)
The data that support the findings of this study are available on request from the corresponding author, upon reasonable request.
Code availability
Not applicable.
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Acknowledgements
This study was partially supported by Italian Ministry of Health—Ricerca Corrente Annual Program 2023.
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FC: design of the study, data collection and analysis, manuscript preparation: writing of the first draft; IC: design of the study, data collection and analysis, manuscript preparation: writing of the first draft and review and critique; AG: design of the study, data collection and analysis, manuscript preparation: writing of the first draft; CB: design of the study, data collection and analysis, manuscript preparation: writing of the first draft and review and critique; VFi: design of the study, data collection and analysis, manuscript preparation: writing of the first draft; GDR: design of the study, data collection and analysis, manuscript preparation: writing of the first draft; AF: design of the study, data collection and analysis, manuscript preparation: writing of the first draft; BD: design of the study, data collection and analysis, manuscript preparation: writing of the first draft; SS: design of the study, data collection and analysis, manuscript preparation: writing of the first draft; NG: design of the study, data collection and analysis, manuscript preparation: writing of the first draft; EB: design of the study, data collection and analysis, manuscript preparation: writing of the first draft; MGC: design of the study, data collection and analysis, manuscript preparation: writing of the first draft; JR: design of the study, data collection and analysis, manuscript preparation: writing of the first draft; FA: design of the study, data collection and analysis, manuscript preparation: writing of the first draft; FCa: design of the study, data collection and analysis, manuscript preparation: writing of the first draft; MAM: design of the study, data collection and analysis, manuscript preparation: writing of the first draft; SC: design of the study, data collection and analysis, manuscript preparation: writing of the first draft; EM: design of the study, data collection and analysis, manuscript preparation: writing of the first draft; AP: design of the study, data collection and analysis, manuscript preparation: writing of the first draft; GV: design of the study, data collection and analysis, manuscript preparation: review and critique; EB: design of the study, data collection and analysis, manuscript preparation: review and critique; GP: design of the study, data collection and analysis, manuscript preparation: review and critique; SM: data collection and analysis, manuscript preparation: review and critique; VFr: data collection and analysis, manuscript preparation: review and critique; AF: design of the study, data collection and analysis, manuscript preparation: writing of the first draft; AV: design of the study, data collection and analysis, manuscript preparation: writing of the first draft; ML: data collection and analysis, manuscript preparation: review and critique; GB: design of the study, data collection and analysis, manuscript preparation: review and critique; AM: design of the study, data collection and analysis, manuscript preparation: writing of the first draft and review and critique; EM: data collection and analysis, manuscript preparation: review and critique; FV: design of the study, data collection and analysis, manuscript preparation: writing of the first draft and review and critique. All the authors. All the authors approve the final version for publication.
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E. Moro has received honoraria from Medtronic, Abbott and Kyowa for consulting services. She has also received grant support from Ipsen and Boston Medical. VF receiving honoraria for lecturing Boston Scientific and Medtronic. All the other authors declare no financial disclosures. The authors declare that they have no conflict of interest.
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The study was approved by the local ethics committee (protocol number: 2019/0056629).
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Cavallieri, F., Campanini, I., Gessani, A. et al. Long-term effects of bilateral subthalamic nucleus deep brain stimulation on gait disorders in Parkinson’s disease: a clinical-instrumental study. J Neurol 270, 4342–4353 (2023). https://doi.org/10.1007/s00415-023-11780-5
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DOI: https://doi.org/10.1007/s00415-023-11780-5