Pozzi Nicoló G, Palmisano Chiara, Reich Martin M, Capetian Philip, Pacchetti Claudio, Volkmann Jens, Isaias Ioannis U
Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Würzburg, Germany.
Parkinson's Disease and Movement Disorders Unit, IRCCS Mondino Foundation, Pavia, Italy.
Front Hum Neurosci. 2022 May 16;16:806513. doi: 10.3389/fnhum.2022.806513. eCollection 2022.
Deep brain stimulation (DBS) of the subthalamic nucleus or the globus pallidus is an established treatment for Parkinson's disease (PD) that yields a marked and lasting improvement of motor symptoms. Yet, DBS benefit on gait disturbances in PD is still debated and can be a source of dissatisfaction and poor quality of life. Gait disturbances in PD encompass a variety of clinical manifestations and rely on different pathophysiological bases. While gait disturbances arising years after DBS surgery can be related to disease progression, early impairment of gait may be secondary to treatable causes and benefits from DBS reprogramming. In this review, we tackle the issue of gait disturbances in PD patients with DBS by discussing their neurophysiological basis, providing a detailed clinical characterization, and proposing a pragmatic programming approach to support their management.
丘脑底核或苍白球的深部脑刺激（DBS）是帕金森病（PD）的一种既定治疗方法，可显著且持久地改善运动症状。然而，DBS对PD步态障碍的益处仍存在争议，并且可能是导致患者不满和生活质量低下的原因。PD中的步态障碍包括多种临床表现，且基于不同的病理生理基础。虽然DBS手术后数年出现的步态障碍可能与疾病进展有关，但早期步态损害可能继发于可治疗的原因，并且可从DBS重新编程中获益。在本综述中，我们通过讨论PD患者DBS步态障碍的神经生理学基础、提供详细的临床特征描述以及提出实用的编程方法来支持其管理，从而解决这一问题。
