Department of Neurology, Semmelweis University, Budapest, Hungary.
National Institute of Clinical Neurosciences, Budapest, Hungary.
PLoS One. 2022 Feb 23;17(2):e0264114. doi: 10.1371/journal.pone.0264114. eCollection 2022.
Balance impairment in Parkinson's disease is multifactorial and its changes due to subthalamic stimulation vary in different studies.
We aimed to analyze the combination of predictive clinical factors of balance impairment in patients with Parkinson's disease treated with bilateral subthalamic stimulation for at least one year.
We recruited 24 patients with Parkinson's disease treated with bilateral subthalamic stimulation and 24 healthy controls. They wore an Opal monitor (APDM Inc.) consisting of three-dimensional gyroscopes and accelerometers in the lumbar region. We investigated four stimulation conditions (bilateral stimulation OFF, bilateral stimulation ON, and unilateral right- and left-sided stimulation ON) with four tests: stance on a plain ground with eyes open and closed, stance on a foam platform with eyes open and closed. Age, disease duration, the time elapsed after implantation, levodopa, and stimulation responsiveness were analyzed. The distance of stimulation location from the subthalamic motor center was calculated individually in each plane of the three dimensions. We analyzed the sway values in the four stimulation conditions in the patient group and compared them with the control values. We explored factor combinations (with age as confounder) in the patient group predictive for imbalance with cluster analysis and a machine-learning-based multiple regression method.
Sway combined from the four tasks did not differ in the patients and controls on a group level. The combination of the disease duration, the preoperative levodopa responsiveness, and the stimulation responsiveness predicted individual stimulation-induced static imbalance. The more affected patients had more severe motor symptoms; primarily, the proprioceptive followed by visual sensory feedback loss provoked imbalance in them when switching on the stimulation.
The duration of the disease, the severity of motor symptoms, the levodopa responsiveness, and additional sensory deficits should be carefully considered during preoperative evaluation to predict subthalamic stimulation-induced imbalance in Parkinson's disease.
帕金森病的平衡障碍是多因素的，其由于丘脑下刺激的变化在不同的研究中有所不同。
我们旨在分析经过至少一年双侧丘脑下刺激治疗的帕金森病患者平衡障碍的预测临床因素的组合。
我们招募了 24 名接受双侧丘脑下刺激治疗的帕金森病患者和 24 名健康对照者。他们在腰部佩戴了一个由三维陀螺仪和加速度计组成的 Opal 监测器（APDM Inc.）。我们研究了四种刺激条件（双侧刺激关闭、双侧刺激开启、单侧右侧和左侧刺激开启）和四种测试：睁眼和闭眼在平地上站立、睁眼和闭眼在泡沫平台上站立。分析了年龄、疾病持续时间、植入后时间、左旋多巴和刺激反应性。在每个三维平面中分别计算了刺激位置与丘脑下运动中心的距离。我们分析了患者组在四种刺激条件下的摆动值，并与对照组的值进行了比较。我们使用聚类分析和基于机器学习的多元回归方法，在患者组中探索了（以年龄为混杂因素）对不平衡有预测作用的因素组合。
在患者和对照组中，四个任务的综合摆动值在组水平上没有差异。疾病持续时间、术前左旋多巴反应性和刺激反应性的组合预测了个体刺激引起的静态不平衡。受影响较大的患者运动症状更严重；主要是本体感觉，其次是视觉感觉反馈丧失，当刺激开启时，他们会感到不平衡。
在术前评估中，应仔细考虑疾病持续时间、运动症状严重程度、左旋多巴反应性和额外的感觉缺陷，以预测帕金森病患者丘脑下刺激引起的平衡障碍。
