Scholten Marlieke, Klemt Johannes, Heilbronn Melanie, Plewnia Christian, Bloem Bastiaan R, Bunjes Friedemann, Krüger Rejko, Gharabaghi Alireza, Weiss Daniel
Department of Neurodegenerative Diseases and Hertie Institute for Clinical Brain Research (HIH), University of Tuebingen, Tuebingen, Germany.
German Centre of Neurodegenerative Diseases (DZNE), University of Tuebingen, Tuebingen, Germany.
Front Neurol. 2017 Oct 17;8:543. doi: 10.3389/fneur.2017.00543. eCollection 2017.
Conventional subthalamic deep brain stimulation for Parkinson's disease (PD) presumably modulates the spatial component of gait. However, temporal dysregulation of gait is one of the factors that is tightly associated with freezing of gait (FOG). Temporal locomotor integration may be modulated differentially at distinct levels of the basal ganglia. Owing to its specific descending brainstem projections, stimulation of the substantia nigra pars reticulata (SNr) area might modulate spatial and temporal parameters of gait differentially compared to standard subthalamic nucleus (STN) stimulation. Here, we aimed to characterize the differential effect of STN or SNr stimulation on kinematic gait parameters. We analyzed biomechanical parameters during unconstrained over ground walking in 12 PD patients with subthalamic deep brain stimulation and FOG. Patients performed walking in three therapeutic conditions: (i) Off stimulation, (ii) STN stimulation (alone), and (iii) SNr stimulation (alone). SNr stimulation was achieved by stimulating the most caudal contact of the electrode. We recorded gait using three sensors (each containing a tri-axial accelerometer, gyroscope, and magnetometer) attached on both left and right ankle, and to the lumbar spine. STN stimulation improved both the spatial features (stride length, stride length variability) and the temporal parameters of gait. SNr stimulation improved temporal parameters of gait (swing time asymmetry). Correlation analysis suggested that patients with more medial localization of the SNr contact associated with a stronger regularization of gait. These results suggest that SNr stimulation might support temporal regularization of gait integration.
传统的丘脑底核深部脑刺激治疗帕金森病（PD）可能会调节步态的空间成分。然而，步态的时间失调是与步态冻结（FOG）密切相关的因素之一。时间运动整合可能在基底神经节的不同水平受到不同的调节。由于黑质网状部（SNr）区域有特定的脑干下行投射，与标准的丘脑底核（STN）刺激相比，刺激SNr区域可能会不同程度地调节步态的空间和时间参数。在此，我们旨在描述STN或SNr刺激对运动步态参数的不同影响。我们分析了12例接受丘脑底核深部脑刺激且有FOG的PD患者在无约束地面行走时的生物力学参数。患者在三种治疗状态下进行行走：（i）关闭刺激，（ii）STN刺激（单独），以及（iii）SNr刺激（单独）。通过刺激电极最尾端的触点实现SNr刺激。我们使用三个传感器（每个传感器都包含一个三轴加速度计、陀螺仪和磁力计）记录步态，这些传感器分别连接在左右脚踝以及腰椎上。STN刺激改善了步态的空间特征（步长、步长变异性）和时间参数。SNr刺激改善了步态的时间参数（摆动时间不对称性）。相关性分析表明，SNr触点位置更靠内侧的患者步态的规律性更强。这些结果表明，SNr刺激可能有助于步态整合的时间规范化。
