Leodori Giorgio, Santilli Marco, Modugno Nicola, D'Avino Michele, De Bartolo Maria Ilenia, Fabbrini Andrea, Rocchi Lorenzo, Conte Antonella, Fabbrini Giovanni, Belvisi Daniele
IRCCS Neuromed, 86077 Pozzilli, Italy.
Department of Human Neuroscience, University of Rome "Sapienza", 00185 Rome, Italy.
Brain Sci. 2023 Aug 25;13(9):1243. doi: 10.3390/brainsci13091243.
Postural instability (PI) in Parkinson's disease (PD) exposes patients to an increased risk of falls (RF). While dopaminergic therapy and deep brain stimulation (DBS) improve motor performance in advanced PD patients, their effects on PI and RF remain elusive. PI and RF were assessed using a stabilometric platform in six advanced PD patients. Patients were evaluated in OFF and ON dopaminergic medication and under four DBS settings: with DBS off, DBS bilateral, and unilateral DBS of the more- or less-affected side. Our findings indicate that dopaminergic medication by itself exacerbated PI and RF, and DBS alone led to a decline in RF. No combination of medication and DBS yielded a superior improvement in postural control compared to the baseline combination of OFF medication and the DBS-off condition. Yet, for ON medication, DBS significantly improved both PI and RF. Among DBS conditions, DBS bilateral provided the most favorable outcomes, improving PI and RF in the ON medication state and presenting the smallest setbacks in the OFF state. Conversely, the more-affected side DBS was less beneficial. These preliminary results could inform therapeutic strategies for advanced PD patients experiencing postural disorders.
帕金森病（PD）中的姿势不稳（PI）使患者面临更高的跌倒风险（RF）。虽然多巴胺能疗法和深部脑刺激（DBS）可改善晚期PD患者的运动表现，但其对PI和RF的影响仍不明确。使用稳定测量平台对6例晚期PD患者的PI和RF进行评估。在患者多巴胺能药物治疗“关”期和“开”期以及四种DBS设置下进行评估：DBS关闭、双侧DBS以及对受影响程度较大或较小一侧进行单侧DBS。我们的研究结果表明，多巴胺能药物本身会加重PI和RF，而单独使用DBS会导致RF下降。与“关”期药物治疗和DBS关闭状态的基线组合相比，药物与DBS的任何组合在姿势控制方面均未产生更优的改善。然而，在药物治疗“开”期，DBS显著改善了PI和RF。在DBS设置中，双侧DBS产生的效果最为理想，在药物治疗“开”期改善了PI和RF，在“关”期的退步最小。相反，对受影响程度较大一侧进行DBS的益处较小。这些初步结果可为患有姿势障碍的晚期PD患者的治疗策略提供参考。
