Gait and balance in essential tremor: Variable effects of bilateral thalamic stimulation
Identifieur interne : 001469 ( Istex/Corpus ); précédent : 001468; suivant : 001470Gait and balance in essential tremor: Variable effects of bilateral thalamic stimulation
Auteurs : Gammon M. Earhart ; B. Ruth Clark ; Samer D. Tabbal ; Joel S. PerlmutterSource :
- Movement Disorders [ 0885-3185 ] ; 2009-02-15.
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Abstract
Essential tremor (ET) is a multi‐faceted condition best known for postural and action tremor but also may include disordered gait and postural instability. Deep brain stimulation (DBS) of the ventral intermediate nucleus (VIM) of the thalamus provides substantial tremor reduction yet some patients with bilateral VIM DBS have gait and balance impairment. This study examines gait and balance performance in 13 participants with ET who have bilateral VIM DBS compared with a matched control group. Participants with ET were tested with their stimulators off (DBS OFF) and on (DBS ON). For both standard and tandem walking, participants with ET walked significantly more slowly than controls, with significantly lower cadence, spending a lower percentage of the gait cycle in single limb support and a higher percentage in double support compared with controls. Participants with ET also had significantly lower tandem and one leg stance times, Berg balance scores, balance confidence, and required significantly greater time to perform the Timed Up‐and‐Go relative to controls. There were no significant differences in any gait or balance measures in the DBS OFF versus DBS ON conditions, but the effects of DBS on gait and balance were highly variable among individuals. Future studies are needed to determine why some individuals experience gait and balance difficulties after bilateral thalamic DBS and others do not. A better understanding of the mechanisms underlying gait and balance impairments in those with bilateral DBS is critical to reduce falls and fractures in this group. © 2008 Movement Disorder Society
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DOI: 10.1002/mds.22356
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<front><div type="abstract" xml:lang="en">Essential tremor (ET) is a multi‐faceted condition best known for postural and action tremor but also may include disordered gait and postural instability. Deep brain stimulation (DBS) of the ventral intermediate nucleus (VIM) of the thalamus provides substantial tremor reduction yet some patients with bilateral VIM DBS have gait and balance impairment. This study examines gait and balance performance in 13 participants with ET who have bilateral VIM DBS compared with a matched control group. Participants with ET were tested with their stimulators off (DBS OFF) and on (DBS ON). For both standard and tandem walking, participants with ET walked significantly more slowly than controls, with significantly lower cadence, spending a lower percentage of the gait cycle in single limb support and a higher percentage in double support compared with controls. Participants with ET also had significantly lower tandem and one leg stance times, Berg balance scores, balance confidence, and required significantly greater time to perform the Timed Up‐and‐Go relative to controls. There were no significant differences in any gait or balance measures in the DBS OFF versus DBS ON conditions, but the effects of DBS on gait and balance were highly variable among individuals. Future studies are needed to determine why some individuals experience gait and balance difficulties after bilateral thalamic DBS and others do not. A better understanding of the mechanisms underlying gait and balance impairments in those with bilateral DBS is critical to reduce falls and fractures in this group. © 2008 Movement Disorder Society</div>
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<keywordGroup xml:lang="en" type="author"><keyword xml:id="kwd1">locomotion</keyword>
<keyword xml:id="kwd2">balance</keyword>
<keyword xml:id="kwd3">essential tremor</keyword>
<keyword xml:id="kwd4">deep brain stimulation</keyword>
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<fundingInfo><fundingAgency>NIH grants</fundingAgency>
<fundingNumber>K01 HD048437</fundingNumber>
<fundingNumber>R01 NS041509</fundingNumber>
</fundingInfo>
<fundingInfo><fundingAgency>American Parkinson Disease Association (APDA) Center for Advanced PD Research at Washington University</fundingAgency>
</fundingInfo>
<fundingInfo><fundingAgency>Greater St. Louis Chapter of the APDA</fundingAgency>
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<fundingInfo><fundingAgency>Barnes‐Jewish Hospital Foundation (the Elliot H. Stein Family Fund and the Jack Buck Fund for PD Research)</fundingAgency>
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<abstractGroup><abstract type="main" xml:lang="en"><title type="main">Abstract</title>
<p>Essential tremor (ET) is a multi‐faceted condition best known for postural and action tremor but also may include disordered gait and postural instability. Deep brain stimulation (DBS) of the ventral intermediate nucleus (VIM) of the thalamus provides substantial tremor reduction yet some patients with bilateral VIM DBS have gait and balance impairment. This study examines gait and balance performance in 13 participants with ET who have bilateral VIM DBS compared with a matched control group. Participants with ET were tested with their stimulators off (DBS OFF) and on (DBS ON). For both standard and tandem walking, participants with ET walked significantly more slowly than controls, with significantly lower cadence, spending a lower percentage of the gait cycle in single limb support and a higher percentage in double support compared with controls. Participants with ET also had significantly lower tandem and one leg stance times, Berg balance scores, balance confidence, and required significantly greater time to perform the Timed Up‐and‐Go relative to controls. There were no significant differences in any gait or balance measures in the DBS OFF versus DBS ON conditions, but the effects of DBS on gait and balance were highly variable among individuals. Future studies are needed to determine why some individuals experience gait and balance difficulties after bilateral thalamic DBS and others do not. A better understanding of the mechanisms underlying gait and balance impairments in those with bilateral DBS is critical to reduce falls and fractures in this group. © 2008 Movement Disorder Society</p>
</abstract>
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<noteGroup><note xml:id="fn5"><p>Potential conflict of interest: None reported.</p>
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<!--Version 0.6 générée le 3-12-2015--><mods version="3.6"><titleInfo lang="en"><title>Gait and balance in essential tremor: Variable effects of bilateral thalamic stimulation</title>
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<titleInfo type="abbreviated" lang="en"><title>Gait and Balance in ET</title>
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<titleInfo type="alternative" contentType="CDATA" lang="en"><title>Gait and balance in essential tremor: Variable effects of bilateral thalamic stimulation</title>
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<name type="personal"><namePart type="given">Gammon M.</namePart>
<namePart type="family">Earhart</namePart>
<namePart type="termsOfAddress">PhD, PT</namePart>
<affiliation>Program in Physical Therapy, Washington University, St. Louis, Missouri, USA</affiliation>
<affiliation>Department of Anatomy and Neurobiology, Washington University, St. Louis, Missouri, USA</affiliation>
<affiliation>Department of Neurology, Washington University, St. Louis, Missouri, USA</affiliation>
<description>Correspondence: Program in Physical Therapy, Washington University School of Medicine, Campus Box 8502, 4444 Forest Park Blvd., St. Louis, MO 63108, USA</description>
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<name type="personal"><namePart type="given">B. Ruth</namePart>
<namePart type="family">Clark</namePart>
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<affiliation>Program in Physical Therapy, Washington University, St. Louis, Missouri, USA</affiliation>
<affiliation>Department of Neurology, Washington University, St. Louis, Missouri, USA</affiliation>
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<name type="personal"><namePart type="given">Samer D.</namePart>
<namePart type="family">Tabbal</namePart>
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<affiliation>Department of Neurology, Washington University, St. Louis, Missouri, USA</affiliation>
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<name type="personal"><namePart type="given">Joel S.</namePart>
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<affiliation>Program in Physical Therapy, Washington University, St. Louis, Missouri, USA</affiliation>
<affiliation>Department of Anatomy and Neurobiology, Washington University, St. Louis, Missouri, USA</affiliation>
<affiliation>Department of Neurology, Washington University, St. Louis, Missouri, USA</affiliation>
<affiliation>Department of Radiology, Washington University, St. Louis, Missouri, USA</affiliation>
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<abstract lang="en">Essential tremor (ET) is a multi‐faceted condition best known for postural and action tremor but also may include disordered gait and postural instability. Deep brain stimulation (DBS) of the ventral intermediate nucleus (VIM) of the thalamus provides substantial tremor reduction yet some patients with bilateral VIM DBS have gait and balance impairment. This study examines gait and balance performance in 13 participants with ET who have bilateral VIM DBS compared with a matched control group. Participants with ET were tested with their stimulators off (DBS OFF) and on (DBS ON). For both standard and tandem walking, participants with ET walked significantly more slowly than controls, with significantly lower cadence, spending a lower percentage of the gait cycle in single limb support and a higher percentage in double support compared with controls. Participants with ET also had significantly lower tandem and one leg stance times, Berg balance scores, balance confidence, and required significantly greater time to perform the Timed Up‐and‐Go relative to controls. There were no significant differences in any gait or balance measures in the DBS OFF versus DBS ON conditions, but the effects of DBS on gait and balance were highly variable among individuals. Future studies are needed to determine why some individuals experience gait and balance difficulties after bilateral thalamic DBS and others do not. A better understanding of the mechanisms underlying gait and balance impairments in those with bilateral DBS is critical to reduce falls and fractures in this group. © 2008 Movement Disorder Society</abstract>
<note type="content">*Potential conflict of interest: None reported.</note>
<note type="funding">NIH grants - No. K01 HD048437; No. R01 NS041509; </note>
<note type="funding">American Parkinson Disease Association (APDA) Center for Advanced PD Research at Washington University</note>
<note type="funding">Greater St. Louis Chapter of the APDA</note>
<note type="funding">Barnes‐Jewish Hospital Foundation (the Elliot H. Stein Family Fund and the Jack Buck Fund for PD Research)</note>
<subject lang="en"><genre>Keywords</genre>
<topic>locomotion</topic>
<topic>balance</topic>
<topic>essential tremor</topic>
<topic>deep brain stimulation</topic>
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<identifier type="ISSN">0885-3185</identifier>
<identifier type="eISSN">1531-8257</identifier>
<identifier type="DOI">10.1002/(ISSN)1531-8257</identifier>
<identifier type="PublisherID">MDS</identifier>
<part><date>2009</date>
<detail type="volume"><caption>vol.</caption>
<number>24</number>
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