Cury Rubens Gisbert, Pavese Nicola, Aziz Tipu Z, Krauss Joachim K, Moro Elena
Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil.
Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK.
NPJ Parkinsons Dis. 2022 Jan 11;8(1):8. doi: 10.1038/s41531-021-00276-6.
Gait issues in Parkinson's disease (PD) are common and can be highly disabling. Although levodopa and deep brain stimulation (DBS) of the subthalamic nucleus and the globus pallidus internus have been established therapies for addressing the motor symptoms of PD, their effects on gait are less predictable and not well sustained with disease progression. Given the high prevalence of gait impairment in PD and the limitations in currently approved therapies, there has been considerable interest in alternative neuromodulation targets and techniques. These have included DBS of pedunculopontine nucleus and substantia nigra pars reticulata, spinal cord stimulation, non-invasive modulation of cortical regions and, more recently, vagus nerve stimulation. However, successes and failures have also emerged with these approaches. Current gaps and controversies are related to patient selection, optimal electrode placement within the target, placebo effects and the optimal programming parameters. Additionally, recent advances in pathophysiology of oscillation dynamics have driven new models of closed-loop DBS systems that may or may not be applicable to gait issues. Our aim is to describe approaches, especially neuromodulation procedures, and emerging challenges to address PD gait issues beyond subthalamic nucleus and the globus pallidus internus stimulation.
帕金森病(PD)中的步态问题很常见,且可能导致严重残疾。尽管左旋多巴以及丘脑底核和苍白球内侧部的深部脑刺激(DBS)已成为治疗PD运动症状的既定疗法,但其对步态的影响较难预测,且随着疾病进展效果难以持久维持。鉴于PD中步态障碍的高患病率以及当前获批疗法的局限性,人们对替代性神经调节靶点和技术产生了浓厚兴趣。这些包括脑桥脚核和黑质网状部的DBS、脊髓刺激、皮质区域的非侵入性调节,以及最近的迷走神经刺激。然而,这些方法也有成功与失败的情况。当前的差距和争议涉及患者选择、靶点内的最佳电极放置、安慰剂效应以及最佳程控参数。此外,振荡动力学病理生理学的最新进展推动了闭环DBS系统的新模型,这些模型可能适用于也可能不适用于步态问题。我们的目的是描述各种方法,尤其是神经调节程序,以及除丘脑底核和苍白球内侧部刺激之外解决PD步态问题所面临的新挑战。