Document Detail


Bilateral subthalamic nucleus deep brain stimulation improves certain aspects of postural control in Parkinson's disease, whereas medication does not.
MedLine Citation:
PMID:  16671073     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Postural control requires precise integration of sensory inputs and motor output, but clinical assessments of postural control do not differentiate between these. Previously, we found that this differentiation is important in Parkinson's disease (PD) as there was a dissociated effect of medication versus pallidotomy on sensory aspects of postural instability. In this study, we address several questions that emerged from that work in 28 different patients with PD off and on medication, before and after bilateral subthalamic nucleus deep brain stimulation (B-STN DBS): (1) In a different cohort is there still an unusually large percentage of patients with postural instability in sensory-deprived conditions? (2) Are more specific measures of motor aspects of postural control using dynamic posturography (postural movement velocity [MV] and reaction time [RT]) abnormal in PD as seen clinically using the Postural Instability and Gait Disorder score of the Unified Parkinson's Disease Rating Scale? (3) What is the effect of B-STN DBS versus medication on sensory versus motor aspects of postural instability in PD? The results included (1) substantially more patients (39%) versus controls (5%) exhibited postural instability in conditions of limited sensory feedback; (2) postural MV and postural RT were abnormal off medication preoperatively (N(subset) = 23; P < 0.001 for both); (3) B-STN DBS improved abnormal sensory aspects of postural instability (P < 0.05) and postural MV (P = 0.005), whereas medication did not. Neither B-STN DBS nor medication improved postural RT. For the group as a whole, STN DBS plus medication was better therapy than medication preoperatively for sensory aspects of postural control (P = 0.003).
Authors:
Nicole Shivitz; Mandy Miller Koop; Jahan Fahimi; Gary Heit; Helen M Bronte-Stewart
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Publication Detail:
Type:  Controlled Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Movement disorders : official journal of the Movement Disorder Society     Volume:  21     ISSN:  0885-3185     ISO Abbreviation:  Mov. Disord.     Publication Date:  2006 Aug 
Date Detail:
Created Date:  2006-08-30     Completed Date:  2007-01-04     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8610688     Medline TA:  Mov Disord     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1088-97     Citation Subset:  IM    
Copyright Information:
(c) 2006 Movement Disorder Society
Affiliation:
Department of Neurology and Neurological Sciences, Stanford University, Stanford, California, USA.
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MeSH Terms
Descriptor/Qualifier:
Brain / physiopathology*
Deep Brain Stimulation
Functional Laterality
Humans
Middle Aged
Motor Activity
Parkinson Disease / physiopathology*,  therapy*
Posture*
Reaction Time
Subthalamic Nucleus / physiopathology*
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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