Armand Stéphane, Landis Theodor, Sztajzel Roman, Burkhard Pierre R
Kinesiology Laboratory, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
Parkinsonism Relat Disord. 2009 Jun;15(5):359-64. doi: 10.1016/j.parkreldis.2008.08.007. Epub 2008 Oct 11.
Parkinson's disease (PD) patients may complain of unsteadiness and impaired balance not only when OFF, but also while being ON with levodopa-induced dyskinesia (LID), yet influence of LID upon postural stability has not been specifically examined. In this study, we addressed this issue using static and dynamic posturography in patients with advanced PD and typical LID. Relevant postural stability parameters were measured on force platforms when patients were OFF and ON, either in quiet standing or when performing leaning tasks designed to stress postural stability. Simultaneously, LID was assessed clinically using a dyskinesia rating scale of severity and subjective unsteadiness was computed. Displacement of the net center of pressure (COPnet), range of COPnet in the mediolateral and antero-posterior directions and 95% confidence ellipse area for both feet were measured as indicators of postural stability and used for comparison analyses. We found a significant increase of COPnet displacement in all tasks up to 556% (mean: 125+/-165%) when patients were ON with dyskinesia compared to the OFF state. In about half of the patients, this increase was marked and correlated with subjective unsteadiness while ON. There was a good correlation between the clinical scores of dyskinesia severity and most COPnet values. Patients demonstrated a tendency to sustain their weight on the foot less affected by dyskinesia, probably as a compensatory mechanism. Our results suggest that LID may compromise balance and independently contribute to postural instability in advanced PD.
帕金森病（PD）患者不仅在“关”期会抱怨步态不稳和平衡受损，在左旋多巴诱导的异动症（LID）的“开”期也会如此，然而LID对姿势稳定性的影响尚未得到专门研究。在本研究中，我们使用静态和动态姿势描记法对晚期PD和典型LID患者进行了研究。当患者处于“关”期和“开”期时，在力平台上测量相关的姿势稳定性参数，测量时患者可处于安静站立状态或进行旨在考验姿势稳定性的倾斜任务。同时，使用异动症严重程度评分量表对LID进行临床评估，并计算主观不稳感。测量双足的净压力中心（COPnet）位移、COPnet在内外侧和前后方向的范围以及95%置信椭圆面积，作为姿势稳定性指标并用于比较分析。我们发现，与“关”期相比，患者在伴有异动症的“开”期时，所有任务中的COPnet位移显著增加，最高可达556%（平均：125±165%）。在大约一半的患者中，这种增加很明显，并且与“开”期的主观不稳感相关。异动症严重程度的临床评分与大多数COPnet值之间存在良好的相关性。患者倾向于将体重更多地支撑在受异动症影响较小的脚上，这可能是一种代偿机制。我们的结果表明，LID可能会损害平衡，并独立导致晚期PD患者的姿势不稳。
