Cani Ilaria, D'Ascanio Ilaria, Baldelli Luca, Lopane Giovanna, Ranciati Saverio, Mantovani Paolo, Conti Alfredo, Cortelli Pietro, Calandra-Buonaura Giovanna, Chiari Lorenzo, Palmerini Luca, Giannini Giulia
UOC Clinica Neurologica Rete Metropolitana NEUROMET, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
Department of Biomedical and NeuroMotor Sciences (DIBINEM), Alma Mater Studiorum - University of Bologna, Bologna, Italy.
Eur J Neurol. 2025 Jan;32(1):e16580. doi: 10.1111/ene.16580.
The efficacy of subthalamic stimulation on axial signs of Parkinson's disease (PD) is debated in the literature. This study delves into the dynamic interplay of gait and posture, specifically probing their nuanced response to subthalamic stimulation and levodopa.
We used wearable sensor technology to examine alterations in the spatiotemporal parameters of gait and posture in individuals with PD before and 6 months after subthalamic deep brain stimulation (STN-DBS) surgery. Thirty-three subjects with PD were evaluated in two pre-operative and four post-operative conditions comprising OFF/ON medication and stimulation states. Standardized response mean (SRM) values were calculated to assess treatment responsiveness.
Significant improvements in spatiotemporal gait parameters, including speed, stride length, cadence, and turning, were observed following STN-DBS surgery. Quantitatively, stimulation outperformed levodopa in enhancing gait speed, stride length, and turning, as indicated by SRM. Levodopa moderately improved stride time variability and asymmetry, while stimulation alone demonstrated limited efficacy. Postural parameters exhibited minimal change following STN-DBS, although stimulation showed a slight benefit in certain postural aspects.
Our findings suggest positive effects of stimulation and levodopa on gait and postural parameters, with STN-DBS demonstrating superior efficacy in enhancing gait speed, stride length, and turning. However, gait variability remains unaddressed by current therapies, highlighting the need for novel treatments targeting regions beyond the basal ganglia.
丘脑底核刺激对帕金森病（PD）轴向症状的疗效在文献中存在争议。本研究深入探讨步态和姿势的动态相互作用，特别探究它们对丘脑底核刺激和左旋多巴的细微反应。
我们使用可穿戴传感器技术，检查帕金森病患者在丘脑底核深部脑刺激（STN-DBS）手术前和术后6个月的步态和姿势时空参数变化。33名帕金森病患者在两种术前和四种术后状态下接受评估，包括药物和刺激的开/关状态。计算标准化反应均值（SRM）值以评估治疗反应性。
STN-DBS手术后，观察到时空步态参数有显著改善，包括速度、步长、步频和转弯。从数量上看，如SRM所示，刺激在提高步态速度、步长和转弯方面优于左旋多巴。左旋多巴适度改善了步幅时间变异性和不对称性，而单独刺激的效果有限。STN-DBS后姿势参数变化最小，尽管刺激在某些姿势方面显示出轻微益处。
我们的研究结果表明刺激和左旋多巴对步态和姿势参数有积极影响，STN-DBS在提高步态速度、步长和转弯方面显示出卓越疗效。然而，目前的治疗方法尚未解决步态变异性问题，凸显了针对基底神经节以外区域的新型治疗方法的必要性。
