[Deep brain stimulation and gait disorders in Parkinson disease]
| Autor: | M-U, Ferraye, B, Debû, P, Pollak |
|---|---|
| Přispěvatelé: | Grenoble Institut des Neurosciences (GIN), Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM), Département de neurologie, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble, Savasta, Marc |
| Jazyk: | francouzština |
| Rok vydání: | 2010 |
| Předmět: |
MESH: Globus Pallidus
MESH: Humans Deep Brain Stimulation MESH: Gait Parkinson Disease Globus Pallidus nervous system diseases Treatment Outcome Subthalamic Nucleus Disease Progression Humans MESH: Disease Progression [SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC] [SDV.NEU] Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC] MESH: Gait Disorders Neurologic MESH: Deep Brain Stimulation Gait Gait Disorders Neurologic MESH: Parkinson Disease MESH: Subthalamic Nucleus MESH: Treatment Outcome |
| Zdroj: | Revue Neurologique Revue Neurologique, Elsevier Masson, 2010, 166 (2), pp.178-87. ⟨10.1016/j.neurol.2009.07.018⟩ |
| ISSN: | 0035-3787 |
| DOI: | 10.1016/j.neurol.2009.07.018⟩ |
| Popis: | International audience; INTRODUCTION: Gait disorders and freezing of gait (FOG) are seen in most patients with advanced Parkinson disease. Response to levodopa and deep brain stimulation is variable across patients. STATE OF ART: Thalamic stimulation is ineffective on gait and can even worsen balance when bilaterally applied. Pallidal stimulation moderately improves gait disorders and FOG although this effect tends to wane after three to five years. Stimulation of the subthalamic nucleus (STN) improves levodopa-responsive gait disorders and FOG. However, some patients worsen after STN stimulation and others are better improved under levodopa than under STN stimulation. Synergistic effects of the two treatments have been reported. As for pallidal stimulation, there is a failure of long-term STN stimulation to improve gait, probably due to the involvement of non-dopaminergic pathways as the disease progresses. Levodopa-resistant gait disorders and FOG do not usually benefit from STN stimulation. In the rare cases of levodopa-induced FOG, STN stimulation may be indirectly effective, as it enables reduction or arrest of the levodopa treatment. PERSPECTIVES: Pedunculopontine nucleus stimulation has recently been performed in small groups of patients with disabling gait disorders and FOG. Although encouraging, the first results need to be confirmed by controlled studies involving larger series of patients. CONCLUSIONS: Overall, gait disorders remain a motor PD symptom that is little improved, or only temporarily, by current pharmacological and surgical treatments. Patient management is complex. |
| Databáze: | OpenAIRE |
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