Seri-Fainshtat Eliraz, Israel Zvi, Weiss Aner, Hausdorff Jeffrey M
J Neuroeng Rehabil. 2013 Apr 15;10:38. doi: 10.1186/1743-0003-10-38.
The beneficial effects of bilateral sub-thalamic nucleus deep brain stimulation on motor function and gait in advanced Parkinson's disease are established. Less is known about the effect of stimulation on cognitive function and the capacity to walk while dual tasking, an ability that has been related to fall risk. Everyday walking takes place in complex environments that often require multi-tasking. Hence, dual tasking gait performance reflects everyday ambulation as well as gait automaticity. The purpose of this study was to examine the impact of sub-thalamic nucleus deep brain stimulation on dual task walking in patients with advanced Parkinson's disease.
Gait was assessed using a performance-based test and by quantifying single-task and dual task walking conditions in 28 patients with advanced Parkinson's disease. These tests were conducted in 4 conditions: "OFF" medication, with the stimulator turned on and off, and "ON" medication, with the stimulator turned on and off. A previously validated, computerized neuro-psychological battery assessed executive function, attention and memory "OFF" and "ON" deep brain stimulation, after subjects took their anti-Parkinsonian medications.
Stimulation improved motor function and the spatiotemporal parameters of gait (e.g., gait speed) during both single-task and dual task walking conditions. Attention improved, but executive function did not. The dual task effect on gait did not change in response to stimulation. For example, during serial 3 subtractions, gait speed was reduced by -0.20 ± 0.14 m/sec while OFF DBS and OFF meds and by -0.22 ± 0.14 m/sec when the DBS was turned on (p = 0.648). Similarly, ON medication, serial 3 subtractions reduced gait speed by -0.20 ± 0.16 m/sec OFF DBS and by -0.22 ± 0.09 m/sec ON DBS (p = 0.543).
Bilateral sub-thalamic nucleus deep brain stimulation improves motor symptoms, certain features of gait and even some aspects of cognitive function. However, stimulation apparently fails to reduce the negative impact of a dual task on walking abilities. These findings provide new insight into the effects of deep brain stimulation on gait during cognitively challenging conditions and everyday walking.
双侧丘脑底核深部脑刺激对晚期帕金森病运动功能和步态的有益作用已得到证实。关于刺激对认知功能以及在执行双重任务时行走能力的影响，人们了解较少，而这种能力与跌倒风险相关。日常行走发生在通常需要进行多任务处理的复杂环境中。因此，双重任务步态表现反映了日常行走以及步态自动性。本研究的目的是探讨丘脑底核深部脑刺激对晚期帕金森病患者双重任务行走的影响。
采用基于表现的测试方法，对28例晚期帕金森病患者的单任务和双重任务行走情况进行量化评估。这些测试在4种条件下进行：“关”药，刺激器开启和关闭；“开”药，刺激器开启和关闭。在受试者服用抗帕金森药物后，使用先前验证过的计算机化神经心理测试组合，评估深部脑刺激“关”和“开”时的执行功能、注意力和记忆力。
在单任务和双重任务行走条件下，刺激均改善了运动功能和步态的时空参数（如步速）。注意力有所改善，但执行功能未改善。刺激对步态的双重任务效应没有改变。例如，在连续减3运算中，深部脑刺激关闭且未服药时步速降低了-0.20±0.14米/秒，深部脑刺激开启时步速降低了-0.22±0.14米/秒（p = 0.648）。同样，在服药状态下，连续减3运算使深部脑刺激关闭时步速降低了-0.20±0.16米/秒，深部脑刺激开启时步速降低了-0.22±0.09米/秒（p = 0.543）。
双侧丘脑底核深部脑刺激可改善运动症状、步态的某些特征，甚至认知功能的某些方面。然而，刺激显然未能减轻双重任务对行走能力的负面影响。这些发现为深部脑刺激在认知挑战性条件下和日常行走中对步态的影响提供了新的见解。
