St George, RJ and Nutt, JG and Burchiel, KJ and Horak, FB, A meta-regression of the long-term effects of deep brain stimulation on balance and gait in PD, Neurology, 75, (14) pp. 1292-1299. ISSN 0028-3878 (2010) [Refereed Article]
Copyright 2010 AAN Enterprises, Inc.
Objective: Deep brain stimulation (DBS) alleviates the cardinal Parkinson disease (PD) symptoms of tremor, rigidity, and bradykinesia. However, its effects on postural instability and gait disability (PIGD) are uncertain. Contradictory findings may be due to differences the in stimulation site and the length of time since DBS surgery. This prompted us to conduct the first meta-regression of long-term studies of bilateral DBS in the subthalamic nucleus (STN) and globus pallidus interna (GPi).
Results: Eleven articles reported a breakdown of the Unified Parkinsonís Disease Rating Scale score before and beyond 3 years postsurgery (mean 4.5 years). Random effects meta-regression revealed that DBS initially improved PIGD compared to the OFF medicated state before surgery, but performance declined over time and extrapolation showed subjects would reach presurgery levels 9 years postsurgery. ON medication, DBS improved PIGD over and above the effect of medication before surgery. Nevertheless, for the STN group, PIGD progressively declined and was worse than presurgery function within 2 years. In contrast, GPi patients showed no significant long-term decline in PIGD in the medicated state. Improvements in cardinal signs with DBS at both sites were maintained across 5 years in the OFF and ON medication states.
Conclusions: DBS alone does not offer the same improvement to PIGD as it does to the cardinal symptoms, suggesting axial and distal control are differentially affected by DBS. GPi DBS in combination with levodopa seemed to preserve PIGD better than did STN DBS, although more studies of GPi DBS and randomized controls are needed.
|Item Type:||Refereed Article|
|Keywords:||meta-analysis Parkinson's Disease DBS balance gait|
|Research Division:||Medical and Health Sciences|
|Research Group:||Human Movement and Sports Science|
|Research Field:||Motor Control|
|Objective Group:||Clinical Health (Organs, Diseases and Abnormal Conditions)|
|Objective Field:||Neurodegenerative Disorders Related to Ageing|
|Author:||St George, RJ (Dr Rebecca St George)|
|Web of Science® Times Cited:||107|
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