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Postural instability and gait disorders after subthalamic nucleus deep brain stimulation in Parkinson’s disease: a PET study

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Abstract

Introduction

Patients with Parkinson’s disease sometimes report postural instability and gait disorders (PIGD) after subthalamic nucleus deep brain stimulation (STN-DBS). Whether this is the direct consequence of DBS or the result of natural disease progression is still subject to debate.

Objective

To compare changes in brain metabolism during STN-DBS between patients with and without PIGD after surgery.

Methods

We extracted consecutive patients from a database where all Rennes Hospital patients undergoing STN-DBS are registered, with regular prospective updates of their clinical data. Patients were divided into two groups (PIGD and No PIGD) according to changes after surgery, as measured with a composite score based on the selected Unified Parkinson’s Disease Rating Scale items. All patients underwent positron emission tomography with 18[F]-fluorodeoxyglucose 3 months before and after surgery. We ran an ANOVA with two factors (group: PIGD vs. No PIGD; and phase: preoperative vs. postoperative) on SPM8 to compare changes in brain metabolism between the two groups.

Results

Participants were 56 patients, including 10 in the PIGD group. The two groups had similar baseline (i.e., before surgery) characteristics. We found two clusters of increased metabolism in the PIGD group relative to the No PIGD group: dorsal midbrain/pons, including locomotor mesencephalic region and reticular pontine formation, and right motor cerebellum.

Conclusion

We found different metabolic changes during DBS-STN among patients with PIGD, concerning brain regions that are already known to be involved in gait disorders in Parkinson’s disease, suggesting that DBS is responsible for the appearance of PIGD.

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Acknowledgements

We thank Elizabeth Wiles-Portier, a native speaker, for editing the manuscript for non-intellectual content.

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Authors and Affiliations

  1. “Behavior and Basal Ganglia” Research Unit, University of Rennes 1, Rennes, France

    Kévin Ahrweiller, J. F. Houvenaghel, A. Riou, S. Drapier, P. Sauleau, M. Vérin, X. Palard & F. Le Jeune

  2. Department of Neurology, University Hospital of Rennes, Rennes, France

    Kévin Ahrweiller, J. F. Houvenaghel, A. Riou, S. Drapier & M. Vérin

  3. Department of Neurophysiology, University Hospital of Rennes, Rennes, France

    P. Sauleau

  4. Department of Neurosurgery, University Hospital of Rennes, Rennes, France

    C. Haegelen

  5. MediCIS” Laboratory, INSERM/University of Rennes 1, Rennes, France

    C. Haegelen & P. Jannin

  6. Department of Nuclear Medicine, Eugene Marquis Hospital Centre, University Hospital of Rennes, Rennes, France

    X. Palard & F. Le Jeune

Authors
  1. Kévin Ahrweiller
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  2. J. F. Houvenaghel
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  3. A. Riou
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  4. S. Drapier
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  5. P. Sauleau
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  6. C. Haegelen
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  8. M. Vérin
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  9. X. Palard
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  10. F. Le Jeune
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Correspondence to Kévin Ahrweiller.

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Ahrweiller, K., Houvenaghel, J.F., Riou, A. et al. Postural instability and gait disorders after subthalamic nucleus deep brain stimulation in Parkinson’s disease: a PET study. J Neurol 266, 2764–2771 (2019). https://doi.org/10.1007/s00415-019-09482-y

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  • DOI: https://doi.org/10.1007/s00415-019-09482-y

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