German Center for Vertigo and Balance Disorders (DSGZ), LMU University Hospital, Ludwig-Maximilians-Universität München, Marchioninistrasse 15, 81377, Munich, Germany.
Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany.
J Neurol. 2024 Aug;271(8):5489-5497. doi: 10.1007/s00415-024-12504-z. Epub 2024 Jun 17.
Gait impairment is a key feature in later stages of Parkinson's disease (PD), which often responds poorly to pharmacological therapies. Neuromodulatory treatment by low-intensity noisy galvanic vestibular stimulation (nGVS) has indicated positive effects on postural instability in PD, which may possibly be conveyed to improvement of dynamic gait dysfunction.
To investigate the effects of individually tuned nGVS on normal and cognitively challenged walking in PD patients with mild-to-moderate gait dysfunction.
Effects of nGVS of varying intensities (0-0.7 mA) on body sway were examined in 32 patients with PD (ON medication state, Hoehn and Yahr: 2.3 ± 0.5), who were standing with eyes closed on a posturographic force plate. Treatment response and optimal nGVS stimulation intensity were determined on an individual patient level. In a second step, the effects of optimal nGVS vs. sham treatment on walking with preferred speed and with a cognitive dual task were investigated by assessment of spatiotemporal gait parameters on a pressure-sensitive gait carpet.
Evaluation of individual balance responses yielded that 59% of patients displayed a beneficial balance response to nGVS treatment with an average optimal improvement of 23%. However, optimal nGVS had no effects on gait parameters neither for the normal nor the cognitively challenged walking condition compared to sham stimulation irrespective of the nGVS responder status.
Low-intensity nGVS seems to have differential treatment effects on static postural imbalance and continuous gait dysfunction in PD, which could be explained by a selective modulation of midbrain-thalamic circuits of balance control.
步态障碍是帕金森病（PD）晚期的一个关键特征，通常对药物治疗反应不佳。经颅直流电刺激（tDCS）的神经调节治疗已表明对 PD 患者的姿势不稳定有积极影响，这可能会改善动态步态障碍。
研究个体化调制的经皮神经电刺激（nGVS）对轻度至中度步态障碍的 PD 患者正常和认知挑战行走的影响。
在 32 名 PD 患者（药物开启状态，Hoehn 和 Yahr 分期：2.3±0.5）中，通过使用足底压力测试系统评估了不同强度（0-0.7 mA）的 nGVS 对身体摆动的影响，患者闭眼站立在足底压力测试系统平台上。在个体患者水平上确定 nGVS 的治疗反应和最佳刺激强度。在第二步中，通过评估压力敏感步态地毯上的时空步态参数，研究最佳 nGVS 与假刺激对以偏好速度行走和认知双重任务行走的影响。
评估个体平衡反应的结果表明，59%的患者对 nGVS 治疗有有益的平衡反应，平均最佳改善率为 23%。然而，与假刺激相比，无论 nGVS 反应者状态如何，最佳 nGVS 对正常和认知挑战行走条件下的步态参数均无影响。
低强度 nGVS 似乎对 PD 中的静态姿势失衡和连续步态障碍有不同的治疗效果，这可以通过对中脑-丘脑平衡控制回路的选择性调节来解释。
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