EFFECT OF SUBTHALAMIC NUCLEUS DEEP BRAIN STIMULATION ON AXIAL MOTOR CONTROL AND PROTECTIVE ARM RESPONSES IN PARKINSON'S DISEASE
Identifieur interne : 002405 ( Main/Exploration ); précédent : 002404; suivant : 002406EFFECT OF SUBTHALAMIC NUCLEUS DEEP BRAIN STIMULATION ON AXIAL MOTOR CONTROL AND PROTECTIVE ARM RESPONSES IN PARKINSON'S DISEASE
Auteurs : J. E. Visser [Pays-Bas, Suisse] ; J. H. J. Allum [Suisse] ; M. G. Carpenter [Suisse, Canada] ; R. A. J. Esselink [Pays-Bas] ; P. Limousin-Dowsey [Royaume-Uni] ; F. Honegger [Suisse] ; G. F. Borm [Pays-Bas] ; B. R. Bloem [Pays-Bas]Source :
- Neuroscience [ 0306-4522 ] ; 2008.
Descripteurs français
- Pascal (Inist)
English descriptors
Abstract
Stereotactic surgical interventions for Parkinson's disease (PD) can considerably improve appendicular motor signs, but their effect on axial motor signs-especially balance control under optimal drug therapy-remains unclear. Here, we investigated the effect of bilateral subthalamic nucleus (STN) stimulation on levodopa-resistant axial and appendicular postural impairment in PD. Fourteen patients (11 with young-onset PD) and 18 age-matched controls were included. Patients were tested after intake of a suprathreshold levodopa dose, ensuring optimal response to drug therapy, and with stimulators both turned on and off. Balance control was assessed using multidirectional dynamic posturography. Outcome measures included full body kinematics and surface electromyography of paraspinal and deltoid muscles. Patients with stimulators turned off showed early decreased trunk roll with a loss of directional dependency, followed by increased and abnormally directed-i.e. destabilizing-trunk roll. Pelvis pitch motion showed decreased directional dependency in these patients. The abnormal trunk motion was not corrected by STN stimulation, but directional dependency of both trunk and pelvis motion partially improved, along with a general decrease in muscle activity. Even with stimulators off, protective arm movements were similar in the optimally treated patients and controls, indicating that these appendicular signs respond better to dopaminergic treatment than axial motor control. Our findings indicate that instability in PD results from a reduced flexibility of the trunk and pelvis that is largely resistant to STN stimulation combined with optimal drug treatment. These postural abnormalities are therefore likely associated with non-dopaminergic pathology. In contrast, protective arm movements did appear to be levodopa-responsive. Future studies should focus on identifying subgroups of optimal responders, particularly patients with levodopa-induced dyskinesias.
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Borm</name><affiliation wicri:level="3"><inist:fA14 i1="06"><s1>Department of Epidemiology and Biostatistics, Radboud University Nijmegen Medical Centre</s1><s2>Nijmegen</s2><s3>NLD</s3><sZ>7 aut.</sZ></inist:fA14><country>Pays-Bas</country><placeName><settlement type="city">Nimègue</settlement><region type="province" nuts="2">Gueldre</region></placeName></affiliation></author><author><name sortKey="Bloem, B R" sort="Bloem, B R" uniqKey="Bloem B" first="B. R." last="Bloem">B. R. 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E." last="Visser">J. E. Visser</name><affiliation wicri:level="3"><inist:fA14 i1="01"><s1>Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen Medical Centre</s1><s2>Nijmegen</s2><s3>NLD</s3><sZ>1 aut.</sZ><sZ>4 aut.</sZ><sZ>8 aut.</sZ></inist:fA14><country>Pays-Bas</country><placeName><settlement type="city">Nimègue</settlement><region type="province" nuts="2">Gueldre</region></placeName></affiliation><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Department of Otorhinolaryngology, University Hospital Basel</s1><s2>Basel</s2><s3>CHE</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>6 aut.</sZ></inist:fA14><country>Suisse</country><wicri:noRegion>Basel</wicri:noRegion></affiliation></author><author><name sortKey="Allum, J H J" sort="Allum, J H J" uniqKey="Allum J" first="J. H. J." last="Allum">J. H. J. Allum</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Department of Otorhinolaryngology, University Hospital Basel</s1><s2>Basel</s2><s3>CHE</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>6 aut.</sZ></inist:fA14><country>Suisse</country><wicri:noRegion>Basel</wicri:noRegion></affiliation></author><author><name sortKey="Carpenter, M G" sort="Carpenter, M G" uniqKey="Carpenter M" first="M. G." last="Carpenter">M. G. Carpenter</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Department of Otorhinolaryngology, University Hospital Basel</s1><s2>Basel</s2><s3>CHE</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>6 aut.</sZ></inist:fA14><country>Suisse</country><wicri:noRegion>Basel</wicri:noRegion></affiliation><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>School of Human Kinetics, University of British Colombia</s1><s2>Vancouver</s2><s3>CAN</s3><sZ>3 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Vancouver</wicri:noRegion></affiliation></author><author><name sortKey="Esselink, R A J" sort="Esselink, R A J" uniqKey="Esselink R" first="R. A. J." last="Esselink">R. A. J. Esselink</name><affiliation wicri:level="3"><inist:fA14 i1="01"><s1>Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen Medical Centre</s1><s2>Nijmegen</s2><s3>NLD</s3><sZ>1 aut.</sZ><sZ>4 aut.</sZ><sZ>8 aut.</sZ></inist:fA14><country>Pays-Bas</country><placeName><settlement type="city">Nimègue</settlement><region type="province" nuts="2">Gueldre</region></placeName></affiliation><affiliation wicri:level="3"><inist:fA14 i1="04"><s1>Department of Geriatrics, Radboud University Nijmegen Medical Centre</s1><s2>Nijmegen</s2><s3>NLD</s3><sZ>4 aut.</sZ></inist:fA14><country>Pays-Bas</country><placeName><settlement type="city">Nimègue</settlement><region type="province" nuts="2">Gueldre</region></placeName></affiliation></author><author><name sortKey="Limousin Dowsey, P" sort="Limousin Dowsey, P" uniqKey="Limousin Dowsey P" first="P." last="Limousin-Dowsey">P. Limousin-Dowsey</name><affiliation wicri:level="3"><inist:fA14 i1="05"><s1>Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, Queen Square</s1><s2>London</s2><s3>GBR</s3><sZ>5 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author><author><name sortKey="Honegger, F" sort="Honegger, F" uniqKey="Honegger F" first="F." last="Honegger">F. Honegger</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Department of Otorhinolaryngology, University Hospital Basel</s1><s2>Basel</s2><s3>CHE</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>6 aut.</sZ></inist:fA14><country>Suisse</country><wicri:noRegion>Basel</wicri:noRegion></affiliation></author><author><name sortKey="Borm, G F" sort="Borm, G F" uniqKey="Borm G" first="G. F." last="Borm">G. F. Borm</name><affiliation wicri:level="3"><inist:fA14 i1="06"><s1>Department of Epidemiology and Biostatistics, Radboud University Nijmegen Medical Centre</s1><s2>Nijmegen</s2><s3>NLD</s3><sZ>7 aut.</sZ></inist:fA14><country>Pays-Bas</country><placeName><settlement type="city">Nimègue</settlement><region type="province" nuts="2">Gueldre</region></placeName></affiliation></author><author><name sortKey="Bloem, B R" sort="Bloem, B R" uniqKey="Bloem B" first="B. R." last="Bloem">B. R. Bloem</name><affiliation wicri:level="3"><inist:fA14 i1="01"><s1>Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen Medical Centre</s1><s2>Nijmegen</s2><s3>NLD</s3><sZ>1 aut.</sZ><sZ>4 aut.</sZ><sZ>8 aut.</sZ></inist:fA14><country>Pays-Bas</country><placeName><settlement type="city">Nimègue</settlement><region type="province" nuts="2">Gueldre</region></placeName></affiliation></author></analytic><series><title level="j" type="main">Neuroscience</title><title level="j" type="abbreviated">Neuroscience</title><idno type="ISSN">0306-4522</idno><imprint><date when="2008">2008</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Neuroscience</title><title level="j" type="abbreviated">Neuroscience</title><idno type="ISSN">0306-4522</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Deep brain stimulation</term><term>Motor control</term><term>Parkinson disease</term><term>Subthalamic nucleus</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Noyau sousthalamique</term><term>Contrôle moteur</term><term>Maladie de Parkinson</term><term>Stimulation cérébrale profonde</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Stereotactic surgical interventions for Parkinson's disease (PD) can considerably improve appendicular motor signs, but their effect on axial motor signs-especially balance control under optimal drug therapy-remains unclear. Here, we investigated the effect of bilateral subthalamic nucleus (STN) stimulation on levodopa-resistant axial and appendicular postural impairment in PD. Fourteen patients (11 with young-onset PD) and 18 age-matched controls were included. Patients were tested after intake of a suprathreshold levodopa dose, ensuring optimal response to drug therapy, and with stimulators both turned on and off. Balance control was assessed using multidirectional dynamic posturography. Outcome measures included full body kinematics and surface electromyography of paraspinal and deltoid muscles. Patients with stimulators turned off showed early decreased trunk roll with a loss of directional dependency, followed by increased and abnormally directed-i.e. destabilizing-trunk roll. Pelvis pitch motion showed decreased directional dependency in these patients. The abnormal trunk motion was not corrected by STN stimulation, but directional dependency of both trunk and pelvis motion partially improved, along with a general decrease in muscle activity. Even with stimulators off, protective arm movements were similar in the optimally treated patients and controls, indicating that these appendicular signs respond better to dopaminergic treatment than axial motor control. Our findings indicate that instability in PD results from a reduced flexibility of the trunk and pelvis that is largely resistant to STN stimulation combined with optimal drug treatment. These postural abnormalities are therefore likely associated with non-dopaminergic pathology. In contrast, protective arm movements did appear to be levodopa-responsive. Future studies should focus on identifying subgroups of optimal responders, particularly patients with levodopa-induced dyskinesias.</div></front></TEI><affiliations><list><country><li>Canada</li><li>Pays-Bas</li><li>Royaume-Uni</li><li>Suisse</li></country><region><li>Angleterre</li><li>Grand Londres</li><li>Gueldre</li></region><settlement><li>Londres</li><li>Nimègue</li></settlement></list><tree><country name="Pays-Bas"><region name="Gueldre"><name sortKey="Visser, J E" sort="Visser, J E" uniqKey="Visser J" first="J. E." last="Visser">J. E. Visser</name></region><name sortKey="Bloem, B R" sort="Bloem, B R" uniqKey="Bloem B" first="B. R." last="Bloem">B. R. Bloem</name><name sortKey="Borm, G F" sort="Borm, G F" uniqKey="Borm G" first="G. F." last="Borm">G. F. Borm</name><name sortKey="Esselink, R A J" sort="Esselink, R A J" uniqKey="Esselink R" first="R. A. J." last="Esselink">R. A. J. Esselink</name><name sortKey="Esselink, R A J" sort="Esselink, R A J" uniqKey="Esselink R" first="R. A. J." last="Esselink">R. A. J. Esselink</name></country><country name="Suisse"><noRegion><name sortKey="Visser, J E" sort="Visser, J E" uniqKey="Visser J" first="J. E." last="Visser">J. E. Visser</name></noRegion><name sortKey="Allum, J H J" sort="Allum, J H J" uniqKey="Allum J" first="J. H. J." last="Allum">J. H. J. Allum</name><name sortKey="Carpenter, M G" sort="Carpenter, M G" uniqKey="Carpenter M" first="M. G." last="Carpenter">M. G. Carpenter</name><name sortKey="Honegger, F" sort="Honegger, F" uniqKey="Honegger F" first="F." last="Honegger">F. Honegger</name></country><country name="Canada"><noRegion><name sortKey="Carpenter, M G" sort="Carpenter, M G" uniqKey="Carpenter M" first="M. G." last="Carpenter">M. G. Carpenter</name></noRegion></country><country name="Royaume-Uni"><region name="Angleterre"><name sortKey="Limousin Dowsey, P" sort="Limousin Dowsey, P" uniqKey="Limousin Dowsey P" first="P." last="Limousin-Dowsey">P. Limousin-Dowsey</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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