Modulation of gait coordination by subthalamic stimulation improves freezing of gait
Identifieur interne : 001512 ( Main/Corpus ); précédent : 001511; suivant : 001513Modulation of gait coordination by subthalamic stimulation improves freezing of gait
Auteurs : Alfonso Fasano ; Jan Herzog ; Elena Seifert ; Henning Stolze ; Daniela Falk ; René Reese ; Jens Volkmann ; Günther DeuschlSource :
- Movement Disorders [ 0885-3185 ] ; 2011-04.
English descriptors
Abstract
The effect of subthalamic deep brain stimulation on gait coordination and freezing of gait in patients with Parkinson's disease is incompletely understood. The purpose of this study was to investigate the extent to which modulation of symmetry and coordination between legs by subthalamic deep brain stimulation alters the frequency and duration of freezing of gait in patients with Parkinson's disease. We recruited 13 post‐subthalamic deep brain stimulation patients with Parkinson's disease with off freezing of gait and evaluated them in the following 4 conditions: subthalamic deep brain stimulation on (ON) and stimulation off (OFF), 50% reduction of stimulation voltage for the leg with shorter step length (worse side reduction) and for the leg with longer step length (better side reduction). Gait analysis was performed on a treadmill and recorded by an optoelectronic analysis system. We measured frequency and duration of freezing of gait episodes. Bilateral coordination of gait was assessed by the Phase Coordination Index, quantifying the ability to generate antiphase stepping. From the OFF to the ON state, freezing of gait improved in frequency (2.0 ± 0.4 to 1.4 ± 0.5 episodes) and duration (12.2 ± 2.6 to 2.6 ± 0.8 seconds; P = .005). Compared with the ON state, only better side reduction further reduced freezing of gait frequency (0.2 ± 0.2) and duration of episodes (0.2 ± 0.2 seconds; P = .03); worse side reduction did not change frequency (1.3 ± 0.4) but increased freezing of gait duration (5.2 ± 2.1 seconds). The better side reduction–associated improvements were accompanied by normalization of gait coordination, as measured by phase coordination index (16.5% ± 6.0%), which was significantly lower than in the other 3 conditions. Reduction of stimulation voltage in the side contralateral to the leg with longer step length improves frequency and duration of freezing of gait through normalization of gait symmetry and coordination in subthalamic deep brain stimulation patients with Parkinson's disease. This identifies poor leg coordination as a risk factor for causing freezing of gait. © 2011 Movement Disorder Society
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DOI: 10.1002/mds.23583
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The purpose of this study was to investigate the extent to which modulation of symmetry and coordination between legs by subthalamic deep brain stimulation alters the frequency and duration of freezing of gait in patients with Parkinson's disease. We recruited 13 post‐subthalamic deep brain stimulation patients with Parkinson's disease with off freezing of gait and evaluated them in the following 4 conditions: subthalamic deep brain stimulation on (ON) and stimulation off (OFF), 50% reduction of stimulation voltage for the leg with shorter step length (worse side reduction) and for the leg with longer step length (better side reduction). Gait analysis was performed on a treadmill and recorded by an optoelectronic analysis system. We measured frequency and duration of freezing of gait episodes. Bilateral coordination of gait was assessed by the Phase Coordination Index, quantifying the ability to generate antiphase stepping. From the OFF to the ON state, freezing of gait improved in frequency (2.0 ± 0.4 to 1.4 ± 0.5 episodes) and duration (12.2 ± 2.6 to 2.6 ± 0.8 seconds; P = .005). Compared with the ON state, only better side reduction further reduced freezing of gait frequency (0.2 ± 0.2) and duration of episodes (0.2 ± 0.2 seconds; P = .03); worse side reduction did not change frequency (1.3 ± 0.4) but increased freezing of gait duration (5.2 ± 2.1 seconds). The better side reduction–associated improvements were accompanied by normalization of gait coordination, as measured by phase coordination index (16.5% ± 6.0%), which was significantly lower than in the other 3 conditions. Reduction of stimulation voltage in the side contralateral to the leg with longer step length improves frequency and duration of freezing of gait through normalization of gait symmetry and coordination in subthalamic deep brain stimulation patients with Parkinson's disease. This identifies poor leg coordination as a risk factor for causing freezing of gait. © 2011 Movement Disorder Society</div></front></TEI><istex><corpusName>wiley</corpusName><author><json:item><name>Alfonso Fasano MD</name><affiliations><json:string>Departments of Neurology and Neurosurgery, Christian‐Albrechts‐University, Kiel, Germany</json:string><json:string>Istituto di Neurologia, Università Cattolica del Sacro Cuore, Rome, Italy</json:string><json:string>IRCCS Neuromed, Pozzilli (IS), Italy</json:string></affiliations></json:item><json:item><name>Jan Herzog MD</name><affiliations><json:string>Departments of Neurology and Neurosurgery, Christian‐Albrechts‐University, Kiel, Germany</json:string></affiliations></json:item><json:item><name>Elena Seifert MD</name><affiliations><json:string>Departments of Neurology and Neurosurgery, Christian‐Albrechts‐University, Kiel, Germany</json:string></affiliations></json:item><json:item><name>Henning Stolze MD</name><affiliations><json:string>Departments of Neurology and Neurosurgery, Christian‐Albrechts‐University, Kiel, Germany</json:string><json:string>Department of Neurology, Diakonissenanstalt, Flensburg, Germany</json:string></affiliations></json:item><json:item><name>Daniela Falk MD</name><affiliations><json:string>Department of Neurology, Diakonissenanstalt, Flensburg, Germany</json:string></affiliations></json:item><json:item><name>René Reese MD</name><affiliations><json:string>Departments of Neurology and Neurosurgery, Christian‐Albrechts‐University, Kiel, Germany</json:string></affiliations></json:item><json:item><name>Jens Volkmann MD</name><affiliations><json:string>Departments of Neurology and Neurosurgery, Christian‐Albrechts‐University, Kiel, Germany</json:string></affiliations></json:item><json:item><name>Günther Deuschl MD</name><affiliations><json:string>Departments of Neurology and Neurosurgery, Christian‐Albrechts‐University, Kiel, Germany</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>Parkinson's disease</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>deep brain stimulation</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>limb coordination</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>asymmetry</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>locomotion</value></json:item></subject><articleId><json:string>MDS23583</json:string></articleId><language><json:string>eng</json:string></language><abstract>The effect of subthalamic deep brain stimulation on gait coordination and freezing of gait in patients with Parkinson's disease is incompletely understood. The purpose of this study was to investigate the extent to which modulation of symmetry and coordination between legs by subthalamic deep brain stimulation alters the frequency and duration of freezing of gait in patients with Parkinson's disease. We recruited 13 post‐subthalamic deep brain stimulation patients with Parkinson's disease with off freezing of gait and evaluated them in the following 4 conditions: subthalamic deep brain stimulation on (ON) and stimulation off (OFF), 50% reduction of stimulation voltage for the leg with shorter step length (worse side reduction) and for the leg with longer step length (better side reduction). Gait analysis was performed on a treadmill and recorded by an optoelectronic analysis system. We measured frequency and duration of freezing of gait episodes. Bilateral coordination of gait was assessed by the Phase Coordination Index, quantifying the ability to generate antiphase stepping. From the OFF to the ON state, freezing of gait improved in frequency (2.0 ± 0.4 to 1.4 ± 0.5 episodes) and duration (12.2 ± 2.6 to 2.6 ± 0.8 seconds; P = .005). Compared with the ON state, only better side reduction further reduced freezing of gait frequency (0.2 ± 0.2) and duration of episodes (0.2 ± 0.2 seconds; P = .03); worse side reduction did not change frequency (1.3 ± 0.4) but increased freezing of gait duration (5.2 ± 2.1 seconds). The better side reduction–associated improvements were accompanied by normalization of gait coordination, as measured by phase coordination index (16.5% ± 6.0%), which was significantly lower than in the other 3 conditions. Reduction of stimulation voltage in the side contralateral to the leg with longer step length improves frequency and duration of freezing of gait through normalization of gait symmetry and coordination in subthalamic deep brain stimulation patients with Parkinson's disease. 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Full financial disclosures and author roles can be found in the online version of this article.</note></notesStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a" type="main" xml:lang="en">Modulation of gait coordination by subthalamic stimulation improves freezing of gait</title><author><persName><forename type="first">Alfonso</forename><surname>Fasano</surname></persName><roleName type="degree">MD</roleName><note type="biography">Alfonso Fasano and Jan Herzog share first authorship.</note><affiliation>Alfonso Fasano and Jan Herzog share first authorship.</affiliation><affiliation>Departments of Neurology and Neurosurgery, Christian‐Albrechts‐University, Kiel, Germany</affiliation><affiliation>Istituto di Neurologia, Università Cattolica del Sacro Cuore, Rome, Italy</affiliation><affiliation>IRCCS Neuromed, Pozzilli (IS), Italy</affiliation></author><author><persName><forename type="first">Jan</forename><surname>Herzog</surname></persName><roleName type="degree">MD</roleName><note type="biography">Alfonso Fasano and Jan Herzog share first authorship.</note><affiliation>Alfonso Fasano and Jan Herzog share first authorship.</affiliation><affiliation>Departments of Neurology and Neurosurgery, Christian‐Albrechts‐University, Kiel, Germany</affiliation></author><author><persName><forename type="first">Elena</forename><surname>Seifert</surname></persName><roleName type="degree">MD</roleName><affiliation>Departments of Neurology and Neurosurgery, Christian‐Albrechts‐University, Kiel, Germany</affiliation></author><author><persName><forename type="first">Henning</forename><surname>Stolze</surname></persName><roleName type="degree">MD</roleName><affiliation>Departments of Neurology and Neurosurgery, Christian‐Albrechts‐University, Kiel, Germany</affiliation><affiliation>Department of Neurology, Diakonissenanstalt, Flensburg, Germany</affiliation></author><author><persName><forename type="first">Daniela</forename><surname>Falk</surname></persName><roleName type="degree">MD</roleName><affiliation>Department of Neurology, Diakonissenanstalt, Flensburg, Germany</affiliation></author><author><persName><forename type="first">René</forename><surname>Reese</surname></persName><roleName type="degree">MD</roleName><affiliation>Departments of Neurology and Neurosurgery, Christian‐Albrechts‐University, Kiel, Germany</affiliation></author><author><persName><forename type="first">Jens</forename><surname>Volkmann</surname></persName><roleName type="degree">MD</roleName><affiliation>Departments of Neurology and Neurosurgery, Christian‐Albrechts‐University, Kiel, Germany</affiliation></author><author><persName><forename type="first">Günther</forename><surname>Deuschl</surname></persName><roleName type="degree">MD</roleName><note type="correspondence"><p>Correspondence: Universityhospital Schleswig‐Holstein, Campus Kiel, Department of Neurology, Schittenhelmstr. 10, 24105 Kiel, Germany</p></note><affiliation>Departments of Neurology and Neurosurgery, Christian‐Albrechts‐University, Kiel, Germany</affiliation></author></analytic><monogr><title level="j">Movement Disorders</title><title level="j" type="abbrev">Mov. Disord.</title><idno type="pISSN">0885-3185</idno><idno type="eISSN">1531-8257</idno><idno type="DOI">10.1002/(ISSN)1531-8257</idno><imprint><publisher>Wiley Subscription Services, Inc., A Wiley Company</publisher><pubPlace>Hoboken</pubPlace><date type="published" when="2011-04"></date><biblScope unit="volume">26</biblScope><biblScope unit="issue">5</biblScope><biblScope unit="page" from="844">844</biblScope><biblScope unit="page" to="851">851</biblScope></imprint></monogr><idno type="istex">A812F462B11ABA0E8C45E575B66DC7D5DC11FB58</idno><idno type="DOI">10.1002/mds.23583</idno><idno type="ArticleID">MDS23583</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2011</date></creation><langUsage><language ident="en">en</language></langUsage><abstract xml:lang="en"><p>The effect of subthalamic deep brain stimulation on gait coordination and freezing of gait in patients with Parkinson's disease is incompletely understood. The purpose of this study was to investigate the extent to which modulation of symmetry and coordination between legs by subthalamic deep brain stimulation alters the frequency and duration of freezing of gait in patients with Parkinson's disease. We recruited 13 post‐subthalamic deep brain stimulation patients with Parkinson's disease with off freezing of gait and evaluated them in the following 4 conditions: subthalamic deep brain stimulation on (ON) and stimulation off (OFF), 50% reduction of stimulation voltage for the leg with shorter step length (worse side reduction) and for the leg with longer step length (better side reduction). Gait analysis was performed on a treadmill and recorded by an optoelectronic analysis system. We measured frequency and duration of freezing of gait episodes. Bilateral coordination of gait was assessed by the Phase Coordination Index, quantifying the ability to generate antiphase stepping. From the OFF to the ON state, freezing of gait improved in frequency (2.0 ± 0.4 to 1.4 ± 0.5 episodes) and duration (12.2 ± 2.6 to 2.6 ± 0.8 seconds; P = .005). Compared with the ON state, only better side reduction further reduced freezing of gait frequency (0.2 ± 0.2) and duration of episodes (0.2 ± 0.2 seconds; P = .03); worse side reduction did not change frequency (1.3 ± 0.4) but increased freezing of gait duration (5.2 ± 2.1 seconds). The better side reduction–associated improvements were accompanied by normalization of gait coordination, as measured by phase coordination index (16.5% ± 6.0%), which was significantly lower than in the other 3 conditions. Reduction of stimulation voltage in the side contralateral to the leg with longer step length improves frequency and duration of freezing of gait through normalization of gait symmetry and coordination in subthalamic deep brain stimulation patients with Parkinson's disease. 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Disord.</title></titleGroup></publicationMeta><publicationMeta level="part" position="50"><doi origin="wiley" registered="yes">10.1002/mds.v26.5</doi><numberingGroup><numbering type="journalVolume" number="26">26</numbering><numbering type="journalIssue">5</numbering></numberingGroup><coverDate startDate="2011-04">April 2011</coverDate></publicationMeta><publicationMeta level="unit" type="article" position="150" status="forIssue"><doi origin="wiley" registered="yes">10.1002/mds.23583</doi><idGroup><id type="unit" value="MDS23583"></id></idGroup><countGroup><count type="pageTotal" number="8"></count></countGroup><titleGroup><title type="articleCategory">Research Article</title><title type="tocHeading1">Research Articles</title></titleGroup><copyright ownership="thirdParty">Copyright © 2011 Movement Disorder Society</copyright><eventGroup><event type="manuscriptReceived" date="2009-12-31"></event><event type="manuscriptRevised" date="2010-11-09"></event><event type="manuscriptAccepted" 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href="file:MDS.MDS23583.pdf"></link></linkGroup></publicationMeta><contentMeta><countGroup><count type="figureTotal" number="3"></count><count type="tableTotal" number="3"></count><count type="referenceTotal" number="42"></count><count type="wordTotal" number="6850"></count></countGroup><titleGroup><title type="main" xml:lang="en">Modulation of gait coordination by subthalamic stimulation improves freezing of gait<link href="#fn1"></link></title><title type="short" xml:lang="en">Asymmetric STN‐DBS Modulates FOG</title></titleGroup><creators><creator xml:id="au1" creatorRole="author" affiliationRef="#af1 #af2 #af3" noteRef="#fn2"><personName><givenNames>Alfonso</givenNames><familyName>Fasano</familyName><degrees>MD</degrees></personName></creator><creator xml:id="au2" creatorRole="author" affiliationRef="#af1" noteRef="#fn2"><personName><givenNames>Jan</givenNames><familyName>Herzog</familyName><degrees>MD</degrees></personName></creator><creator xml:id="au3" creatorRole="author" affiliationRef="#af1"><personName><givenNames>Elena</givenNames><familyName>Seifert</familyName><degrees>MD</degrees></personName></creator><creator xml:id="au4" creatorRole="author" affiliationRef="#af1 #af4"><personName><givenNames>Henning</givenNames><familyName>Stolze</familyName><degrees>MD</degrees></personName></creator><creator xml:id="au5" creatorRole="author" affiliationRef="#af4"><personName><givenNames>Daniela</givenNames><familyName>Falk</familyName><degrees>MD</degrees></personName></creator><creator xml:id="au6" creatorRole="author" affiliationRef="#af1"><personName><givenNames>René</givenNames><familyName>Reese</familyName><degrees>MD</degrees></personName></creator><creator xml:id="au7" creatorRole="author" affiliationRef="#af1"><personName><givenNames>Jens</givenNames><familyName>Volkmann</familyName><degrees>MD</degrees></personName></creator><creator xml:id="au8" creatorRole="author" affiliationRef="#af1" corresponding="yes"><personName><givenNames>Günther</givenNames><familyName>Deuschl</familyName><degrees>MD</degrees></personName><contactDetails><email normalForm="g.deuschl@ neurologie.uni-kiel.de">g.deuschl@ neurologie.uni‐kiel.de</email></contactDetails></creator></creators><affiliationGroup><affiliation xml:id="af1" countryCode="DE" type="organization"><unparsedAffiliation>Departments of Neurology and Neurosurgery, Christian‐Albrechts‐University, Kiel, Germany</unparsedAffiliation></affiliation><affiliation xml:id="af2" countryCode="IT" type="organization"><unparsedAffiliation>Istituto di Neurologia, Università Cattolica del Sacro Cuore, Rome, Italy</unparsedAffiliation></affiliation><affiliation xml:id="af3" countryCode="IT" type="organization"><unparsedAffiliation>IRCCS Neuromed, Pozzilli (IS), Italy</unparsedAffiliation></affiliation><affiliation xml:id="af4" countryCode="DE" type="organization"><unparsedAffiliation>Department of Neurology, Diakonissenanstalt, Flensburg, Germany</unparsedAffiliation></affiliation></affiliationGroup><keywordGroup xml:lang="en" type="author"><keyword xml:id="kwd1">Parkinson's disease</keyword><keyword xml:id="kwd2">deep brain stimulation</keyword><keyword xml:id="kwd3">limb coordination</keyword><keyword xml:id="kwd4">asymmetry</keyword><keyword xml:id="kwd5">locomotion</keyword></keywordGroup><supportingInformation><p> Additional Supporting Information may be found in the online version of this article. </p><supportingInfoItem><mediaResource alt="supporting information" href="urn-x:wiley:08853185:media:mds23583:MDS_23583_sm_authorroles"></mediaResource><caption>Author Roles and Disclosures</caption></supportingInfoItem><supportingInfoItem><mediaResource alt="supporting information" href="urn-x:wiley:08853185:media:mds23583:MDS_23583_sm_suppinfofig1"></mediaResource><caption>Supporting Figure A: UPDRS III total score (A) and lower limb score (B) during different stimulation conditions. Note the reversal of stimulation benefit for the lower limbs during worse side reduction (WSR) and better side reduction (BSR) compared to ON condition. Effects of WSR and BSR are separately displayed for the leg with the longer (better side) and shorter (worse side) stride length. OFF: subthalamic deep brain stimulation (STN‐DBS) off, ON: subthalamic deep brain stimulation (STN‐DBS) on, BSR: better side, i.e. leg with the longer stride length; WSR: worse side, i.e. leg with the shorter stride length. *: P<0.05, **: P<0.01, ***: P<0.001.</caption></supportingInfoItem><supportingInfoItem><mediaResource alt="supporting information" href="urn-x:wiley:08853185:media:mds23583:MDS_23583_sm_suppinfomov"></mediaResource><caption>Supporting Information Movie</caption></supportingInfoItem><supportingInfoItem><mediaResource alt="supporting information" href="urn-x:wiley:08853185:media:mds23583:MDS_23583_sm_suppinfo"></mediaResource><caption>Supporting Information</caption></supportingInfoItem></supportingInformation><abstractGroup><abstract type="main" xml:lang="en"><title type="main">Abstract</title><p>The effect of subthalamic deep brain stimulation on gait coordination and freezing of gait in patients with Parkinson's disease is incompletely understood. The purpose of this study was to investigate the extent to which modulation of symmetry and coordination between legs by subthalamic deep brain stimulation alters the frequency and duration of freezing of gait in patients with Parkinson's disease. We recruited 13 post‐subthalamic deep brain stimulation patients with Parkinson's disease with off freezing of gait and evaluated them in the following 4 conditions: subthalamic deep brain stimulation on (ON) and stimulation off (OFF), 50% reduction of stimulation voltage for the leg with shorter step length (worse side reduction) and for the leg with longer step length (better side reduction). Gait analysis was performed on a treadmill and recorded by an optoelectronic analysis system. We measured frequency and duration of freezing of gait episodes. Bilateral coordination of gait was assessed by the Phase Coordination Index, quantifying the ability to generate antiphase stepping. From the OFF to the ON state, freezing of gait improved in frequency (2.0 ± 0.4 to 1.4 ± 0.5 episodes) and duration (12.2 ± 2.6 to 2.6 ± 0.8 seconds; <i>P</i> = .005). Compared with the ON state, only better side reduction further reduced freezing of gait frequency (0.2 ± 0.2) and duration of episodes (0.2 ± 0.2 seconds; <i>P</i> = .03); worse side reduction did not change frequency (1.3 ± 0.4) but increased freezing of gait duration (5.2 ± 2.1 seconds). The better side reduction–associated improvements were accompanied by normalization of gait coordination, as measured by phase coordination index (16.5% ± 6.0%), which was significantly lower than in the other 3 conditions. Reduction of stimulation voltage in the side contralateral to the leg with longer step length improves frequency and duration of freezing of gait through normalization of gait symmetry and coordination in subthalamic deep brain stimulation patients with Parkinson's disease. This identifies poor leg coordination as a risk factor for causing freezing of gait. © 2011 Movement Disorder Society</p></abstract></abstractGroup></contentMeta><noteGroup><note xml:id="fn1"><p><b>Relevant conflicts of interest/financial disclosures:</b> Nothing to report. Full financial disclosures and author roles can be found in the online version of this article.</p></note><note xml:id="fn2"><p>Alfonso Fasano and Jan Herzog share first authorship.</p></note></noteGroup></header></component></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Modulation of gait coordination by subthalamic stimulation improves freezing of gait</title></titleInfo><titleInfo type="abbreviated" lang="en"><title>Asymmetric STN‐DBS Modulates FOG</title></titleInfo><titleInfo type="alternative" contentType="CDATA" lang="en"><title>Modulation of gait coordination by subthalamic stimulation improves freezing of gait</title></titleInfo><name type="personal"><namePart type="given">Alfonso</namePart><namePart type="family">Fasano</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Departments of Neurology and Neurosurgery, Christian‐Albrechts‐University, Kiel, Germany</affiliation><affiliation>Istituto di Neurologia, Università Cattolica del Sacro Cuore, Rome, Italy</affiliation><affiliation>IRCCS Neuromed, Pozzilli (IS), Italy</affiliation><description>Alfonso Fasano and Jan Herzog share first authorship.</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Jan</namePart><namePart type="family">Herzog</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Departments of Neurology and Neurosurgery, Christian‐Albrechts‐University, Kiel, Germany</affiliation><description>Alfonso Fasano and Jan Herzog share first authorship.</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Elena</namePart><namePart type="family">Seifert</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Departments of Neurology and Neurosurgery, Christian‐Albrechts‐University, Kiel, Germany</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Henning</namePart><namePart type="family">Stolze</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Departments of Neurology and Neurosurgery, Christian‐Albrechts‐University, Kiel, Germany</affiliation><affiliation>Department of Neurology, Diakonissenanstalt, Flensburg, Germany</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Daniela</namePart><namePart type="family">Falk</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Department of Neurology, Diakonissenanstalt, Flensburg, Germany</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">René</namePart><namePart type="family">Reese</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Departments of Neurology and Neurosurgery, Christian‐Albrechts‐University, Kiel, Germany</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Jens</namePart><namePart type="family">Volkmann</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Departments of Neurology and Neurosurgery, Christian‐Albrechts‐University, Kiel, Germany</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Günther</namePart><namePart type="family">Deuschl</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Departments of Neurology and Neurosurgery, Christian‐Albrechts‐University, Kiel, Germany</affiliation><description>Correspondence: Universityhospital Schleswig‐Holstein, Campus Kiel, Department of Neurology, Schittenhelmstr. 10, 24105 Kiel, Germany</description><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="article" displayLabel="article"></genre><originInfo><publisher>Wiley Subscription Services, Inc., A Wiley Company</publisher><place><placeTerm type="text">Hoboken</placeTerm></place><dateIssued encoding="w3cdtf">2011-04</dateIssued><dateCaptured encoding="w3cdtf">2009-12-31</dateCaptured><dateValid encoding="w3cdtf">2010-11-16</dateValid><copyrightDate encoding="w3cdtf">2011</copyrightDate></originInfo><language><languageTerm type="code" authority="rfc3066">en</languageTerm><languageTerm type="code" authority="iso639-2b">eng</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType><extent unit="figures">3</extent><extent unit="tables">3</extent><extent unit="references">42</extent><extent unit="words">6850</extent></physicalDescription><abstract lang="en">The effect of subthalamic deep brain stimulation on gait coordination and freezing of gait in patients with Parkinson's disease is incompletely understood. The purpose of this study was to investigate the extent to which modulation of symmetry and coordination between legs by subthalamic deep brain stimulation alters the frequency and duration of freezing of gait in patients with Parkinson's disease. We recruited 13 post‐subthalamic deep brain stimulation patients with Parkinson's disease with off freezing of gait and evaluated them in the following 4 conditions: subthalamic deep brain stimulation on (ON) and stimulation off (OFF), 50% reduction of stimulation voltage for the leg with shorter step length (worse side reduction) and for the leg with longer step length (better side reduction). Gait analysis was performed on a treadmill and recorded by an optoelectronic analysis system. We measured frequency and duration of freezing of gait episodes. Bilateral coordination of gait was assessed by the Phase Coordination Index, quantifying the ability to generate antiphase stepping. From the OFF to the ON state, freezing of gait improved in frequency (2.0 ± 0.4 to 1.4 ± 0.5 episodes) and duration (12.2 ± 2.6 to 2.6 ± 0.8 seconds; P = .005). Compared with the ON state, only better side reduction further reduced freezing of gait frequency (0.2 ± 0.2) and duration of episodes (0.2 ± 0.2 seconds; P = .03); worse side reduction did not change frequency (1.3 ± 0.4) but increased freezing of gait duration (5.2 ± 2.1 seconds). The better side reduction–associated improvements were accompanied by normalization of gait coordination, as measured by phase coordination index (16.5% ± 6.0%), which was significantly lower than in the other 3 conditions. Reduction of stimulation voltage in the side contralateral to the leg with longer step length improves frequency and duration of freezing of gait through normalization of gait symmetry and coordination in subthalamic deep brain stimulation patients with Parkinson's disease. This identifies poor leg coordination as a risk factor for causing freezing of gait. © 2011 Movement Disorder Society</abstract><note type="content">*Relevant conflicts of interest/financial disclosures: Nothing to report. Full financial disclosures and author roles can be found in the online version of this article.</note><subject lang="en"><genre>Keywords</genre><topic>Parkinson's disease</topic><topic>deep brain stimulation</topic><topic>limb coordination</topic><topic>asymmetry</topic><topic>locomotion</topic></subject><relatedItem type="host"><titleInfo><title>Movement Disorders</title></titleInfo><titleInfo type="abbreviated"><title>Mov. Disord.</title></titleInfo><genre type="Journal">journal</genre><note type="content"> Additional Supporting Information may be found in the online version of this article.Supporting Info Item: Author Roles and Disclosures - Supporting Figure A: UPDRS III total score (A) and lower limb score (B) during different stimulation conditions. Note the reversal of stimulation benefit for the lower limbs during worse side reduction (WSR) and better side reduction (BSR) compared to ON condition. Effects of WSR and BSR are separately displayed for the leg with the longer (better side) and shorter (worse side) stride length. OFF: subthalamic deep brain stimulation (STN‐DBS) off, ON: subthalamic deep brain stimulation (STN‐DBS) on, BSR: better side, i.e. leg with the longer stride length; WSR: worse side, i.e. leg with the shorter stride length. *: P<0.05, **: P<0.01, ***: P<0.001. - Supporting Information Movie - Supporting Information - </note><subject><genre>article category</genre><topic>Research Article</topic></subject><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>2011</date><detail type="volume"><caption>vol.</caption><number>26</number></detail><detail type="issue"><caption>no.</caption><number>5</number></detail><extent unit="pages"><start>844</start><end>851</end><total>8</total></extent></part></relatedItem><identifier type="istex">A812F462B11ABA0E8C45E575B66DC7D5DC11FB58</identifier><identifier type="DOI">10.1002/mds.23583</identifier><identifier type="ArticleID">MDS23583</identifier><accessCondition type="use and reproduction" contentType="copyright">Copyright © 2011 Movement Disorder Society</accessCondition><recordInfo><recordContentSource>WILEY</recordContentSource><recordOrigin>Wiley Subscription Services, Inc., A Wiley Company</recordOrigin></recordInfo></mods></metadata><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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