Gait and Balance in Essential Tremor: Variable Effects of Bilateral Thalamic Stimulation
Identifieur interne : 002432 ( Ncbi/Merge ); précédent : 002431; suivant : 002433Gait and Balance in Essential Tremor: Variable Effects of Bilateral Thalamic Stimulation
Auteurs : Gammon M. Earhart [États-Unis] ; B. Ruth Clark [États-Unis] ; Samer D. Tabbal [États-Unis] ; Joel S. Perlmutter [États-Unis]Source :
- Movement disorders : official journal of the Movement Disorder Society [ 0885-3185 ] ; 2009.
English descriptors
- KwdEn :
- Adult, Aged, Deep Brain Stimulation (methods), Essential Tremor (epidemiology), Essential Tremor (physiopathology), Essential Tremor (therapy), Female, Gait Disorders, Neurologic (epidemiology), Gait Disorders, Neurologic (physiopathology), Gait Disorders, Neurologic (therapy), Humans, Male, Middle Aged, Postural Balance (physiology), Severity of Illness Index, Thalamus (physiopathology), Treatment Outcome.
- MESH :
- epidemiology : Essential Tremor, Gait Disorders, Neurologic.
- methods : Deep Brain Stimulation.
- physiology : Postural Balance.
- physiopathology : Essential Tremor, Gait Disorders, Neurologic, Thalamus.
- therapy : Essential Tremor, Gait Disorders, Neurologic.
- Adult, Aged, Female, Humans, Male, Middle Aged, Severity of Illness Index, Treatment Outcome.
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 to 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 to 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 in order to reduce falls and fractures in this group.
Url:
DOI: 10.1002/mds.22356
PubMed: 19006189
PubMed Central: 2882155
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<front><div type="abstract" xml:lang="en"><p id="P1">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 to 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 to 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 in order to reduce falls and fractures in this group.</p>
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<orgName type="university" n="3">École de médecine (Université Washington de Saint-Louis)</orgName>
<orgName type="institution">Université Washington de Saint-Louis</orgName>
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<affiliation wicri:level="2"><nlm:aff id="A2"> Department of Anatomy & Neurobiology, Washington University, St. Louis, MO, USA</nlm:aff>
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<wicri:regionArea> Department of Anatomy & Neurobiology, Washington University, St. Louis, MO</wicri:regionArea>
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<affiliation wicri:level="2"><nlm:aff id="A3"> Department of Neurology, Washington University, St. Louis, MO, USA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea> Department of Neurology, Washington University, St. Louis, MO</wicri:regionArea>
<placeName><region type="state">Missouri (État)</region>
</placeName>
<placeName><settlement type="city">Saint-Louis (Missouri)</settlement>
<region type="state">Missouri (État)</region>
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<orgName type="university" n="3">École de médecine (Université Washington de Saint-Louis)</orgName>
<orgName type="institution">Université Washington de Saint-Louis</orgName>
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</author>
<author><name sortKey="Clark, B Ruth" sort="Clark, B Ruth" uniqKey="Clark B" first="B. Ruth" last="Clark">B. Ruth Clark</name>
<affiliation wicri:level="2"><nlm:aff id="A1"> Program in Physical Therapy, Washington University, St. Louis, MO, USA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea> Program in Physical Therapy, Washington University, St. Louis, MO</wicri:regionArea>
<placeName><region type="state">Missouri (État)</region>
</placeName>
</affiliation>
<affiliation wicri:level="2"><nlm:aff id="A3"> Department of Neurology, Washington University, St. Louis, MO, USA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea> Department of Neurology, Washington University, St. Louis, MO</wicri:regionArea>
<placeName><region type="state">Missouri (État)</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Tabbal, Samer D" sort="Tabbal, Samer D" uniqKey="Tabbal S" first="Samer D." last="Tabbal">Samer D. Tabbal</name>
<affiliation wicri:level="2"><nlm:aff id="A3"> Department of Neurology, Washington University, St. Louis, MO, USA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea> Department of Neurology, Washington University, St. Louis, MO</wicri:regionArea>
<placeName><region type="state">Missouri (État)</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Perlmutter, Joel S" sort="Perlmutter, Joel S" uniqKey="Perlmutter J" first="Joel S." last="Perlmutter">Joel S. Perlmutter</name>
<affiliation wicri:level="2"><nlm:aff id="A1"> Program in Physical Therapy, Washington University, St. Louis, MO, USA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea> Program in Physical Therapy, Washington University, St. Louis, MO</wicri:regionArea>
<placeName><region type="state">Missouri (État)</region>
</placeName>
</affiliation>
<affiliation wicri:level="2"><nlm:aff id="A2"> Department of Anatomy & Neurobiology, Washington University, St. Louis, MO, USA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea> Department of Anatomy & Neurobiology, Washington University, St. Louis, MO</wicri:regionArea>
<placeName><region type="state">Missouri (État)</region>
</placeName>
</affiliation>
<affiliation wicri:level="2"><nlm:aff id="A3"> Department of Neurology, Washington University, St. Louis, MO, USA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea> Department of Neurology, Washington University, St. Louis, MO</wicri:regionArea>
<placeName><region type="state">Missouri (État)</region>
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</affiliation>
<affiliation wicri:level="2"><nlm:aff id="A4"> Department of Radiology, Washington University, St. Louis, MO, USA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea> Department of Radiology, Washington University, St. Louis, MO</wicri:regionArea>
<placeName><region type="state">Missouri (État)</region>
</placeName>
</affiliation>
</author>
</analytic>
<series><title level="j">Movement disorders : official journal of the Movement Disorder Society</title>
<idno type="ISSN">0885-3185</idno>
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<front><div type="abstract" xml:lang="en"><p id="P1">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 to 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 to 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 in order to reduce falls and fractures in this group.</p>
</div>
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<pubmed><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Gait and balance in essential tremor: variable effects of bilateral thalamic stimulation.</title>
<author><name sortKey="Earhart, Gammon M" sort="Earhart, Gammon M" uniqKey="Earhart G" first="Gammon M" last="Earhart">Gammon M. Earhart</name>
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<wicri:regionArea>Program in Physical Therapy, Washington University, St. Louis, Missouri 63108</wicri:regionArea>
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</author>
<author><name sortKey="Clark, B Ruth" sort="Clark, B Ruth" uniqKey="Clark B" first="B Ruth" last="Clark">B Ruth Clark</name>
</author>
<author><name sortKey="Tabbal, Samer D" sort="Tabbal, Samer D" uniqKey="Tabbal S" first="Samer D" last="Tabbal">Samer D. Tabbal</name>
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<author><name sortKey="Perlmutter, Joel S" sort="Perlmutter, Joel S" uniqKey="Perlmutter J" first="Joel S" last="Perlmutter">Joel S. Perlmutter</name>
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<sourceDesc><biblStruct><analytic><title xml:lang="en">Gait and balance in essential tremor: variable effects of bilateral thalamic stimulation.</title>
<author><name sortKey="Earhart, Gammon M" sort="Earhart, Gammon M" uniqKey="Earhart G" first="Gammon M" last="Earhart">Gammon M. Earhart</name>
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<orgName type="institution">Université Washington de Saint-Louis</orgName>
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<author><name sortKey="Clark, B Ruth" sort="Clark, B Ruth" uniqKey="Clark B" first="B Ruth" last="Clark">B Ruth Clark</name>
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<author><name sortKey="Tabbal, Samer D" sort="Tabbal, Samer D" uniqKey="Tabbal S" first="Samer D" last="Tabbal">Samer D. Tabbal</name>
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<author><name sortKey="Perlmutter, Joel S" sort="Perlmutter, Joel S" uniqKey="Perlmutter J" first="Joel S" last="Perlmutter">Joel S. Perlmutter</name>
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<term>Aged</term>
<term>Deep Brain Stimulation (methods)</term>
<term>Essential Tremor (epidemiology)</term>
<term>Essential Tremor (physiopathology)</term>
<term>Essential Tremor (therapy)</term>
<term>Female</term>
<term>Gait Disorders, Neurologic (epidemiology)</term>
<term>Gait Disorders, Neurologic (physiopathology)</term>
<term>Gait Disorders, Neurologic (therapy)</term>
<term>Humans</term>
<term>Male</term>
<term>Middle Aged</term>
<term>Postural Balance (physiology)</term>
<term>Severity of Illness Index</term>
<term>Thalamus (physiopathology)</term>
<term>Treatment Outcome</term>
</keywords>
<keywords scheme="MESH" qualifier="epidemiology" xml:lang="en"><term>Essential Tremor</term>
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<term>Gait Disorders, Neurologic</term>
<term>Thalamus</term>
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<term>Gait Disorders, Neurologic</term>
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<term>Aged</term>
<term>Female</term>
<term>Humans</term>
<term>Male</term>
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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.</div>
</front>
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