Effects of nigral stimulation on locomotion and postural stability in patients with Parkinson's disease.
نویسندگان
چکیده
The physiopathology of gait and balance disorders in Parkinson's disease patients is still poorly understood. Levodopa treatment and subthalamic nucleus (STN) stimulation improve step length and walking speed, with less effect on postural instability. These disorders have been linked to dysfunction of the descending basal ganglia outputs to brainstem structures. In this study, we evaluated the effects of stimulation of the substantia nigra pars reticulata (SNr), on locomotion and balance in Parkinson's disease patients. Biomechanical parameters and leg muscle activity were recorded during gait initiation in seven selected patients operated for bilateral STN stimulation, out of 204 stimulated patients, with one contact of each electrode located within the SNr. Step length, anteroposterior and vertical velocities of the centre of gravity were studied, with special reference to the subjects' ability to brake the centre of gravity fall before foot-contact, and compared to seven controls. In Parkinson's disease patients, five treatment conditions were tested: (i) no treatment, (ii) levodopa treatment, (iii) STN stimulation, (iv) SNr stimulation and (v) combined levodopa treatment and STN stimulation. The effects of these treatments on motor parkinsonian disability were assessed with the UPDRS III scale, separated into 'axial' (rising from chair, posture, postural stability and gait) and 'distal' scores. Whereas levodopa and/or STN stimulation improved 'axial' and 'distal' motor symptoms, SNr stimulation improved only the 'axial' symptoms. Compared to controls, untreated Parkinson's disease patients showed reduced step length and velocity, and poor braking just prior to foot-contact, with a decrease in both soleus (S) and anterior tibialis (AT) muscle activity. Step length and velocity significantly increased with levodopa treatment alone or in combination with STN stimulation in both natural and fast gait conditions, and with STN stimulation alone in the fast gait condition. Conversely, SNr stimulation had no significant effect on these measures in either condition. In the natural gait condition, no fall in the centre of gravity occurred as step length was low and active braking was unnecessary. In the fast gait condition, braking was improved with STN or SNr stimulation but not with levodopa treatment, with an increase in the stance leg S muscle activity. These results suggest that anteroposterior (length and velocity) and vertical (braking capacity) gait parameters are controlled by two distinct systems within the basal ganglia circuitry, representing respectively locomotion and balance. The SNr, a major basal ganglia output known to project to pontomesencephalic structures, is postulated as being particularly involved in balance control during gait.
منابع مشابه
Pilates Exercise and Functional Balance in Parkinson\'s Disease
Background: Parkinson's disease as a progressive disorder of the nervous system leads to the disability of postural control system. Objectives: In the present study the effects of Pilates exercises on functional balance in patients with Parkinson's was investigated. Materials and Methods: This control trial included 30 patients with idiopathic Parkinson's disease who were selected as subj...
متن کاملThe Effect of Repetitive Transcranial Magnetic Stimulation on Postural Stability After Acute Stroke: A Clinical Trial
Introduction: Balance impairment is a common problem and a major cause of motor disability after stroke. Therefore, this study aimed to investigate whether low-frequency repetitive Transcranial Magnetic Stimulation (rTMS) improves the postural balance problems in stroke patients. Methods: This randomized double blind clinical trial with 12 weeks follow-up was conducted on stroke patients. Trea...
متن کاملEffect of whole body vibration on ankle joint proprioception and balance in patients with diabetic neuropathy
Introduction: One of the most common manifestations of diabetic peripheral neuropathy is postural impairment and proprioception deficits. Whole Body Vibration (WBV) is a relatively new somatosensory stimulation, the effects of which on balance and proprioception in patients with diabetic neuropathy have not been adequately studied. This study aimed to investigate the effects of WBV on balance a...
متن کاملبررسی تغییرات فرایند طرح حرکتی به پاسخ های وضعیتی عضلات تنه در افراد سالم و بیماران با سابقه کمردرد
The changes that occur in all of the motor unit recruitment following the central and peripheral lesions of motor nerves can be effective on individual's disability. Following the low back pain (L.B.P) with any known cause, the effective role of muscles in providing postural or dynamic stability will be reduced. Today in rehabilitation of these patients, except of medical treatment for reductio...
متن کاملDisordered axial movement in Parkinson's disease.
Axial motor impairments are a common cause of disability in patients with Parkinson's disease, become more prominent with longer disease duration, and have been said to be less responsive to levodopa replacement therapy. The ability to turn in bed while lying supine before and after dopaminergic stimulation was studied in a group of 36 patients with Parkinson's disease; 23 were in Hoehn and Yah...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید
ثبت ناماگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید
ورودعنوان ژورنال:
- Brain : a journal of neurology
دوره 132 Pt 1 شماره
صفحات -
تاریخ انتشار 2009