Parkinsonian gait improves with bilateral subthalamic nucleus deep brain stimulation during cognitive multi-tasking

• Published in: Parkinsonism & related disorders 2017-05, Vol.38, p.72-79
• Main Authors: Chenji, Gaurav, MS, Wright, Melissa L., MPT, Chou, Kelvin L., MD, Seidler, Rachael D., PhD, Patil, Parag G., MD PhD
• Format: Article
• Language: English
• Subjects: Aged; Analysis of Variance; Biomechanical Phenomena; Cognition Disorders - diagnosis; Cognition Disorders - etiology; Cognitive impairment; Deep brain stimulation; Deep Brain Stimulation - methods; Dual-task; Female; Functional Laterality - physiology; Gait; Gait Disorders, Neurologic - etiology; Gait Disorders, Neurologic - therapy; Humans; Male; Middle Aged; Neurology; Neuropsychological Tests; Parkinson Disease - complications; Parkinson Disease - therapy; Parkinson's disease; Subthalamic Nucleus - physiology; Treatment Outcome; Walking - physiology
• ISSN: 1353-8020; 1873-5126
• DOI: 10.1016/j.parkreldis.2017.02.028

Abstract Background Gait impairment in Parkinson's disease reduces mobility and increases fall risk, particularly during cognitive multi-tasking. Studies suggest that bilateral subthalamic deep brain stimulation, a common surgical therapy, degrades motor performance under cognitive dual-task conditions, compared to unilateral stimulation. Objective To measure the impact of bilateral versus unilateral subthalamic deep brain stimulation on walking kinematics with and without cognitive dual-tasking. Methods Gait kinematics of seventeen patients with advanced Parkinson's disease who had undergone bilateral subthalamic deep brain stimulation were examined off medication under three stimulation states (bilateral, unilateral left, unilateral right) with and without a cognitive challenge, using an instrumented walkway system. Results Consistent with earlier studies, gait performance declined for all six measured parameters under cognitive dual-task conditions, independent of stimulation state. However, bilateral stimulation produced greater improvements in step length and double-limb support time than unilateral stimulation, and achieved similar performance for other gait parameters. Conclusions Contrary to expectations from earlier studies of dual-task motor performance, bilateral subthalamic deep brain stimulation may assist in maintaining temporal and spatial gait performance under cognitive dual-task conditions.