Stereotactic and Functional Neurosurgery, CTO Hospital, ASL RMC, Rome, Italy.
Biomechanics and Movement Analysis Laboratory, Physical Medicine and Rehabilitation, University of Rome La Sapienza, Italy.
Gait Posture. 2014 Jul;40(3):357-62. doi: 10.1016/j.gaitpost.2014.05.002. Epub 2014 May 14.
The pedunculopontine tegmental nucleus (PPTg) is a component of the locomotor mesencephalic area. In recent years it has been considered a new surgical site for deep brain stimulation (DBS) in movement disorders. Here, using objective kinematic and spatio-temporal gait analysis, we report the impact of low frequency (40 Hz) unilateral PPTg DBS in ten patients suffering from idiopathic Parkinson's disease with drug-resistant gait and axial disabilities. Patients were studied for gait initiation (GI) and steady-state level walking (LW) under residual drug therapy. In the LW study, a straight walking task was employed. Patients were compared with healthy age-matched controls. The analysis revealed that GI, cadence, stride length and left pelvic tilt range of motion (ROM) improved under stimulation. The duration of the S1 and S2 sub-phases of the anticipatory postural adjustment phase of GI was not affected by stimulation, however a significant improvement was observed in the S1 sub-phase in both the backward shift of centre of pressure and peak velocity. Speed during the swing phase, step width, stance duration, right pelvic tilt ROM phase, right and left hip flexion-extension ROM, and right and left knee ROM were not modified. Overall, the results show that unilateral PPTg DBS may affect GI and specific spatio-temporal and kinematic parameters during unconstrained walking on a straight trajectory, thus providing further support to the importance of the PPTg in the modulation of gait in neurodegenerative disorders.
被盖脚桥核（PPTg）是运动性中脑区的组成部分。近年来，它被认为是深部脑刺激（DBS）治疗运动障碍的新手术靶点。在这里，我们使用客观的运动学和时空步态分析，报告了低频（40Hz）单侧 PPTg DBS 对 10 名患有药物抵抗性步态和轴性障碍的特发性帕金森病患者的影响。在残留药物治疗下，对患者进行步态启动（GI）和稳态水平行走（LW）研究。在 LW 研究中，采用了直线行走任务。将患者与年龄匹配的健康对照组进行比较。分析结果显示，刺激可改善 GI、步频、步长和左骨盆倾斜运动范围（ROM）。然而，刺激对 GI 预备姿势调整阶段 S1 和 S2 亚相的持续时间没有影响，但在 S1 亚相中，压力中心向后移动和峰值速度均有显著改善。摆动阶段的速度、步宽、站立持续时间、右骨盆倾斜 ROM 相位、右和左髋关节屈伸 ROM 以及右和左膝关节 ROM 均未改变。总的来说，这些结果表明，单侧 PPTg DBS 可能影响 GI 以及在直线路径上自由行走时的特定时空和运动学参数，从而进一步支持 PPTg 在神经退行性疾病步态调节中的重要性。
