Impact of subthalamic nucleus stimulation on the initiation of gait in Parkinson's disease

• Published in: Experimental brain research Vol. 172; no. 4; pp. 519 - 532
• Main Authors: CRENNA, P, CARPINELLA, I, RABUFFETTI, M, RIZZONE, M, LOPIANO, L, LANOTTE, M, FERRARIN, M
• Format: Journal Article
• Language: English
• Published: Berlin Springer 01.07.2006; Springer Nature B.V
• Subjects: Aged; Analysis of Variance; Biological and medical sciences; Biomechanical Phenomena; Deep Brain Stimulation - methods; Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases; Electromyography - methods; Female; Fundamental and applied biological sciences. Psychology; Gait - radiation effects; Humans; Male; Medical sciences; Middle Aged; Motor control and motor pathways. Reflexes. Control centers of vegetative functions. Vestibular system and equilibration; Neurology; Parkinson Disease - physiopathology; Parkinson Disease - therapy; Postural Balance - physiology; Postural Balance - radiation effects; Posture - physiology; Subthalamic Nucleus - physiopathology; Subthalamic Nucleus - radiation effects; Vertebrates: nervous system and sense organs; Parkinson's disease; Gait; Deep brain stimulation; Central nervous system; Lower limb; Parkinson disease; Anticipation; Synergism; Posture; Osteoarticular system; Initiation of gait; Kinematics; Degenerative disease; Muscle; Subthalamic nucleus; Human; Nervous system diseases; Idiopathic; Anticipatory postural adjustments; Joint; Motor control; Hip; Cerebral disorder; Central nervous system disease; Extrapyramidal syndrome
• ISSN: 0014-4819; 1432-1106
• DOI: 10.1007/s00221-006-0360-7

The effects of subthalamic nucleus (STN) stimulation on the anticipatory postural actions associated with the initiation of gait were studied in ten patients with idiopathic Parkinson's disease undergoing therapeutic deep brain stimulation. Kinematic, dynamic and electromyographic analysis was performed before and while subjects were starting gait in response to an external cue. Effects of STN stimulation on the standing posture preceding the go signal included significant improvement of the vertical alignment of the trunk and shank, decrease of the hip joint moment, backward shift of the center of pressure (CoP) and reduction of abnormal tonic and/or rhythmic activity in the thigh and leg muscles. Responses to bilateral STN stimulation were more consistent than those evoked by unilateral stimulation. Moreover, comparison between postural changes induced by STN stimulation applied prior to the gait initiation cue and during simple quiet standing revealed more significant responses in the former condition. Effects on the actual gait initiation process included shortening of the imbalance phase, larger backward/lateral displacement of CoP and more physiological expression of the underlying anticipatory muscular synergy. Additional changes were shortening of the unloading phase, shortening of the first-swing phase and increase in the length of the first step. Results demonstrate substantial influence of STN stimulation on functionally basic motor control mechanisms. In particular, the evidence of more significant responses upon attention-demanding conditions and the remarkable effects on postural programmes sub-serving feed-forward regulation of the onset of complex multijoint movements, suggests a consistent action on postural sub-systems relying on cognitive data processing and internal models of body mechanics.