The Dominant-Subthalamic Nucleus Phenomenon in Bilateral Deep Brain Stimulation for Parkinson’s Disease: Evidence from a Gait Analysis Study
BackgroundIt has been suggested that parkinsonian [Parkinson’s disease (PD)] patients might have a “dominant” (DOM) subthalamic nucleus (STN), whose unilateral electrical stimulation [deep brain stimulation (DBS)] could lead to an improvement in PD symptoms similar to bilateral STN-DBS.ObjectivesSin...
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doaj-fd2d6785011443bf9e9a4d5d8dd9975f2020-11-24T20:54:22ZengFrontiers Media S.A.Frontiers in Neurology1664-22952017-10-01810.3389/fneur.2017.00575297842The Dominant-Subthalamic Nucleus Phenomenon in Bilateral Deep Brain Stimulation for Parkinson’s Disease: Evidence from a Gait Analysis StudyMario Giorgio Rizzone0Maurizio Ferrarin1Michele Maria Lanotte2Leonardo Lopiano3Ilaria Carpinella4Department of Neuroscience Rita Levi Montalcini, University of Turin, Turin, ItalyBiomedical Technology Department, IRCCS Don Carlo Gnocchi Foundation, Milan, ItalyDepartment of Neuroscience Rita Levi Montalcini, University of Turin, Turin, ItalyDepartment of Neuroscience Rita Levi Montalcini, University of Turin, Turin, ItalyBiomedical Technology Department, IRCCS Don Carlo Gnocchi Foundation, Milan, ItalyBackgroundIt has been suggested that parkinsonian [Parkinson’s disease (PD)] patients might have a “dominant” (DOM) subthalamic nucleus (STN), whose unilateral electrical stimulation [deep brain stimulation (DBS)] could lead to an improvement in PD symptoms similar to bilateral STN-DBS.ObjectivesSince disability in PD patients is often related to gait problems, in this study, we wanted to investigate in a group of patients bilaterally implanted for STN-DBS: (1) if it was possible to identify a subgroup of subjects with a dominant STN; (2) in the case, if the unilateral stimulation of the dominant STN was capable to improve gait abnormalities, as assessed by instrumented multifactorial gait analysis, similarly to what observed with bilateral stimulation.MethodsWe studied 10 PD patients with bilateral STN-DBS. A clinical evaluation and a kinematic, kinetic, and electromyographic (EMG) analysis of overground walking were performed—off medication—in four conditions: without stimulation, with bilateral stimulation, with unilateral right or left STN-DBS. Through a hierarchical agglomerative cluster analysis based on motor Unified Parkinson’s Disease Rating Scale scores, it was possible to separate patients into two groups, based on the presence (six patients, DOM group) or absence (four patients, NDOM group) of a dominant STN.ResultsIn the DOM group, both bilateral and unilateral stimulation of the dominant STN significantly increased gait speed, stride length, range of motion of lower limb joints, and peaks of moment and power at the ankle joint; moreover, the EMG activation pattern of distal leg muscles was improved. The unilateral stimulation of the non-dominant STN did not produce any significant effect. In the NDOM group, only bilateral stimulation determined a significant improvement of gait parameters.ConclusionIn the DOM group, the effect of unilateral stimulation of the dominant STN determined an improvement of gait parameters similar to bilateral stimulation. The pre-surgical identification of these patients, if possible, could allow to reduce the surgical risks and side effects of DBS adopting a unilateral approach.http://journal.frontiersin.org/article/10.3389/fneur.2017.00575/fullParkinson’s diseasedeep brain stimulationdominant subthalamic nucleusgaitinstrumented movement analysiskinematics |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Mario Giorgio Rizzone Maurizio Ferrarin Michele Maria Lanotte Leonardo Lopiano Ilaria Carpinella |
spellingShingle |
Mario Giorgio Rizzone Maurizio Ferrarin Michele Maria Lanotte Leonardo Lopiano Ilaria Carpinella The Dominant-Subthalamic Nucleus Phenomenon in Bilateral Deep Brain Stimulation for Parkinson’s Disease: Evidence from a Gait Analysis Study Frontiers in Neurology Parkinson’s disease deep brain stimulation dominant subthalamic nucleus gait instrumented movement analysis kinematics |
author_facet |
Mario Giorgio Rizzone Maurizio Ferrarin Michele Maria Lanotte Leonardo Lopiano Ilaria Carpinella |
author_sort |
Mario Giorgio Rizzone |
title |
The Dominant-Subthalamic Nucleus Phenomenon in Bilateral Deep Brain Stimulation for Parkinson’s Disease: Evidence from a Gait Analysis Study |
title_short |
The Dominant-Subthalamic Nucleus Phenomenon in Bilateral Deep Brain Stimulation for Parkinson’s Disease: Evidence from a Gait Analysis Study |
title_full |
The Dominant-Subthalamic Nucleus Phenomenon in Bilateral Deep Brain Stimulation for Parkinson’s Disease: Evidence from a Gait Analysis Study |
title_fullStr |
The Dominant-Subthalamic Nucleus Phenomenon in Bilateral Deep Brain Stimulation for Parkinson’s Disease: Evidence from a Gait Analysis Study |
title_full_unstemmed |
The Dominant-Subthalamic Nucleus Phenomenon in Bilateral Deep Brain Stimulation for Parkinson’s Disease: Evidence from a Gait Analysis Study |
title_sort |
dominant-subthalamic nucleus phenomenon in bilateral deep brain stimulation for parkinson’s disease: evidence from a gait analysis study |
publisher |
Frontiers Media S.A. |
series |
Frontiers in Neurology |
issn |
1664-2295 |
publishDate |
2017-10-01 |
description |
BackgroundIt has been suggested that parkinsonian [Parkinson’s disease (PD)] patients might have a “dominant” (DOM) subthalamic nucleus (STN), whose unilateral electrical stimulation [deep brain stimulation (DBS)] could lead to an improvement in PD symptoms similar to bilateral STN-DBS.ObjectivesSince disability in PD patients is often related to gait problems, in this study, we wanted to investigate in a group of patients bilaterally implanted for STN-DBS: (1) if it was possible to identify a subgroup of subjects with a dominant STN; (2) in the case, if the unilateral stimulation of the dominant STN was capable to improve gait abnormalities, as assessed by instrumented multifactorial gait analysis, similarly to what observed with bilateral stimulation.MethodsWe studied 10 PD patients with bilateral STN-DBS. A clinical evaluation and a kinematic, kinetic, and electromyographic (EMG) analysis of overground walking were performed—off medication—in four conditions: without stimulation, with bilateral stimulation, with unilateral right or left STN-DBS. Through a hierarchical agglomerative cluster analysis based on motor Unified Parkinson’s Disease Rating Scale scores, it was possible to separate patients into two groups, based on the presence (six patients, DOM group) or absence (four patients, NDOM group) of a dominant STN.ResultsIn the DOM group, both bilateral and unilateral stimulation of the dominant STN significantly increased gait speed, stride length, range of motion of lower limb joints, and peaks of moment and power at the ankle joint; moreover, the EMG activation pattern of distal leg muscles was improved. The unilateral stimulation of the non-dominant STN did not produce any significant effect. In the NDOM group, only bilateral stimulation determined a significant improvement of gait parameters.ConclusionIn the DOM group, the effect of unilateral stimulation of the dominant STN determined an improvement of gait parameters similar to bilateral stimulation. The pre-surgical identification of these patients, if possible, could allow to reduce the surgical risks and side effects of DBS adopting a unilateral approach. |
topic |
Parkinson’s disease deep brain stimulation dominant subthalamic nucleus gait instrumented movement analysis kinematics |
url |
http://journal.frontiersin.org/article/10.3389/fneur.2017.00575/full |
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