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Evaluating gait and postural responses to subthalamic stimulation and levodopa: A prospective study using wearable technology
Background The efficacy of subthalamic stimulation on axial signs of Parkinson's disease (PD) is debated in the literature. This study delves into the dynamic interplay of gait and posture, specifically probing their nuanced response to subthalamic stimulation and levodopa. Methods We used wear...
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| Published in: | European journal of neurology 2025-01, Vol.32 (1), p.e16580-n/a |
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| container_title | European journal of neurology |
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| creator | Cani, Ilaria D'Ascanio, Ilaria Baldelli, Luca Lopane, Giovanna Ranciati, Saverio Mantovani, Paolo Conti, Alfredo Cortelli, Pietro Calandra‐Buonaura, Giovanna Chiari, Lorenzo Palmerini, Luca Giannini, Giulia |
| description | Background
The efficacy of subthalamic stimulation on axial signs of Parkinson's disease (PD) is debated in the literature. This study delves into the dynamic interplay of gait and posture, specifically probing their nuanced response to subthalamic stimulation and levodopa.
Methods
We used wearable sensor technology to examine alterations in the spatiotemporal parameters of gait and posture in individuals with PD before and 6 months after subthalamic deep brain stimulation (STN‐DBS) surgery. Thirty‐three subjects with PD were evaluated in two pre‐operative and four post‐operative conditions comprising OFF/ON medication and stimulation states. Standardized response mean (SRM) values were calculated to assess treatment responsiveness.
Results
Significant improvements in spatiotemporal gait parameters, including speed, stride length, cadence, and turning, were observed following STN‐DBS surgery. Quantitatively, stimulation outperformed levodopa in enhancing gait speed, stride length, and turning, as indicated by SRM. Levodopa moderately improved stride time variability and asymmetry, while stimulation alone demonstrated limited efficacy. Postural parameters exhibited minimal change following STN‐DBS, although stimulation showed a slight benefit in certain postural aspects.
Conclusion
Our findings suggest positive effects of stimulation and levodopa on gait and postural parameters, with STN‐DBS demonstrating superior efficacy in enhancing gait speed, stride length, and turning. However, gait variability remains unaddressed by current therapies, highlighting the need for novel treatments targeting regions beyond the basal ganglia. |
| doi_str_mv | 10.1111/ene.16580 |
| format | article |
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The efficacy of subthalamic stimulation on axial signs of Parkinson's disease (PD) is debated in the literature. This study delves into the dynamic interplay of gait and posture, specifically probing their nuanced response to subthalamic stimulation and levodopa.
Methods
We used wearable sensor technology to examine alterations in the spatiotemporal parameters of gait and posture in individuals with PD before and 6 months after subthalamic deep brain stimulation (STN‐DBS) surgery. Thirty‐three subjects with PD were evaluated in two pre‐operative and four post‐operative conditions comprising OFF/ON medication and stimulation states. Standardized response mean (SRM) values were calculated to assess treatment responsiveness.
Results
Significant improvements in spatiotemporal gait parameters, including speed, stride length, cadence, and turning, were observed following STN‐DBS surgery. Quantitatively, stimulation outperformed levodopa in enhancing gait speed, stride length, and turning, as indicated by SRM. Levodopa moderately improved stride time variability and asymmetry, while stimulation alone demonstrated limited efficacy. Postural parameters exhibited minimal change following STN‐DBS, although stimulation showed a slight benefit in certain postural aspects.
Conclusion
Our findings suggest positive effects of stimulation and levodopa on gait and postural parameters, with STN‐DBS demonstrating superior efficacy in enhancing gait speed, stride length, and turning. However, gait variability remains unaddressed by current therapies, highlighting the need for novel treatments targeting regions beyond the basal ganglia.</description><identifier>ISSN: 1351-5101</identifier><identifier>ISSN: 1468-1331</identifier><identifier>EISSN: 1468-1331</identifier><identifier>DOI: 10.1111/ene.16580</identifier><identifier>PMID: 39702816</identifier><language>eng</language><publisher>England: John Wiley & Sons, Inc</publisher><subject>Aged ; Antiparkinson Agents - therapeutic use ; Basal ganglia ; Deep brain stimulation ; Deep Brain Stimulation - methods ; Effectiveness ; Evaluation ; Female ; Gait ; Gait - drug effects ; Gait - physiology ; Gait Disorders, Neurologic - etiology ; Gait Disorders, Neurologic - therapy ; Gait recognition ; Ganglia ; Humans ; inertial measurement units ; kinematic analysis ; Levodopa ; Levodopa - administration & dosage ; Levodopa - pharmacology ; Levodopa - therapeutic use ; Male ; Middle Aged ; Movement disorders ; Neurodegenerative diseases ; neuromodulation ; Parameters ; Parkinson Disease - drug therapy ; Parkinson Disease - therapy ; Parkinson's disease ; Postural Balance - drug effects ; Postural Balance - physiology ; Posture ; Posture - physiology ; Prospective Studies ; Solitary tract nucleus ; Stimulation ; Subthalamic Nucleus - drug effects ; Surgery ; Turning gait ; Variability ; Wearable Electronic Devices ; Wearable technology</subject><ispartof>European journal of neurology, 2025-01, Vol.32 (1), p.e16580-n/a</ispartof><rights>2024 The Author(s). published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.</rights><rights>2024 The Author(s). European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.</rights><rights>2024. This article is published under http://creativecommons.org/licenses/by-nc-nd/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c2430-eb50bec2819df90988732f67205ffa21631637c682f38a2b434a09e307ce9f613</cites><orcidid>0000-0002-0499-3236 ; 0000-0002-3633-8818</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fene.16580$$EPDF$$P50$$Gwiley$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fene.16580$$EHTML$$P50$$Gwiley$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,11542,27903,27904,46030,46454</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39702816$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Cani, Ilaria</creatorcontrib><creatorcontrib>D'Ascanio, Ilaria</creatorcontrib><creatorcontrib>Baldelli, Luca</creatorcontrib><creatorcontrib>Lopane, Giovanna</creatorcontrib><creatorcontrib>Ranciati, Saverio</creatorcontrib><creatorcontrib>Mantovani, Paolo</creatorcontrib><creatorcontrib>Conti, Alfredo</creatorcontrib><creatorcontrib>Cortelli, Pietro</creatorcontrib><creatorcontrib>Calandra‐Buonaura, Giovanna</creatorcontrib><creatorcontrib>Chiari, Lorenzo</creatorcontrib><creatorcontrib>Palmerini, Luca</creatorcontrib><creatorcontrib>Giannini, Giulia</creatorcontrib><title>Evaluating gait and postural responses to subthalamic stimulation and levodopa: A prospective study using wearable technology</title><title>European journal of neurology</title><addtitle>Eur J Neurol</addtitle><description>Background
The efficacy of subthalamic stimulation on axial signs of Parkinson's disease (PD) is debated in the literature. This study delves into the dynamic interplay of gait and posture, specifically probing their nuanced response to subthalamic stimulation and levodopa.
Methods
We used wearable sensor technology to examine alterations in the spatiotemporal parameters of gait and posture in individuals with PD before and 6 months after subthalamic deep brain stimulation (STN‐DBS) surgery. Thirty‐three subjects with PD were evaluated in two pre‐operative and four post‐operative conditions comprising OFF/ON medication and stimulation states. Standardized response mean (SRM) values were calculated to assess treatment responsiveness.
Results
Significant improvements in spatiotemporal gait parameters, including speed, stride length, cadence, and turning, were observed following STN‐DBS surgery. Quantitatively, stimulation outperformed levodopa in enhancing gait speed, stride length, and turning, as indicated by SRM. Levodopa moderately improved stride time variability and asymmetry, while stimulation alone demonstrated limited efficacy. Postural parameters exhibited minimal change following STN‐DBS, although stimulation showed a slight benefit in certain postural aspects.
Conclusion
Our findings suggest positive effects of stimulation and levodopa on gait and postural parameters, with STN‐DBS demonstrating superior efficacy in enhancing gait speed, stride length, and turning. However, gait variability remains unaddressed by current therapies, highlighting the need for novel treatments targeting regions beyond the basal ganglia.</description><subject>Aged</subject><subject>Antiparkinson Agents - therapeutic use</subject><subject>Basal ganglia</subject><subject>Deep brain stimulation</subject><subject>Deep Brain Stimulation - methods</subject><subject>Effectiveness</subject><subject>Evaluation</subject><subject>Female</subject><subject>Gait</subject><subject>Gait - drug effects</subject><subject>Gait - physiology</subject><subject>Gait Disorders, Neurologic - etiology</subject><subject>Gait Disorders, Neurologic - therapy</subject><subject>Gait recognition</subject><subject>Ganglia</subject><subject>Humans</subject><subject>inertial measurement units</subject><subject>kinematic analysis</subject><subject>Levodopa</subject><subject>Levodopa - administration & dosage</subject><subject>Levodopa - pharmacology</subject><subject>Levodopa - therapeutic use</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Movement disorders</subject><subject>Neurodegenerative diseases</subject><subject>neuromodulation</subject><subject>Parameters</subject><subject>Parkinson Disease - drug therapy</subject><subject>Parkinson Disease - therapy</subject><subject>Parkinson's disease</subject><subject>Postural Balance - drug effects</subject><subject>Postural Balance - physiology</subject><subject>Posture</subject><subject>Posture - physiology</subject><subject>Prospective Studies</subject><subject>Solitary tract nucleus</subject><subject>Stimulation</subject><subject>Subthalamic Nucleus - drug effects</subject><subject>Surgery</subject><subject>Turning gait</subject><subject>Variability</subject><subject>Wearable Electronic Devices</subject><subject>Wearable technology</subject><issn>1351-5101</issn><issn>1468-1331</issn><issn>1468-1331</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2025</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><recordid>eNp1kbtOwzAUhi0EglIYeAFkiQWGtHaci8NWVeUiVbDAHDnOSRvkxCG2W3Xg3XEvMCBhWbKH73z6j36ErigZUX_G0MKIJjEnR2hAo4QHlDF67P8spkFMCT1D58Z8EELCNCSn6IxlKQk5TQboa7YSyglbtwu8ELXFoi1xp411vVC4B9Pp1oDBVmPjCrsUSjS1xMbWjVN-TLe7CQUrXepO3OMJ7nptOpC2XoHnXLnBzmz1axC9KBRgC3LZaqUXmwt0Ugll4PLwDtH7w-xt-hTMXx-fp5N5IMOIkQCKmBQgfeKsrDKScZ6ysEr8LnFViZAmzN9UJjysGBdhEbFIkAwYSSVkVULZEN3uvT7bpwNj86Y2EpQSLWhnckajNOIRYVv05g_6oV3f-nSeilOepSzOPHW3p6Rf1vRQ5V1fN6Lf5JTk205y30m-68Sz1wejKxoof8mfEjww3gPrWsHmf1M-e5ntld_38pbH</recordid><startdate>202501</startdate><enddate>202501</enddate><creator>Cani, Ilaria</creator><creator>D'Ascanio, Ilaria</creator><creator>Baldelli, Luca</creator><creator>Lopane, Giovanna</creator><creator>Ranciati, Saverio</creator><creator>Mantovani, Paolo</creator><creator>Conti, Alfredo</creator><creator>Cortelli, Pietro</creator><creator>Calandra‐Buonaura, Giovanna</creator><creator>Chiari, Lorenzo</creator><creator>Palmerini, Luca</creator><creator>Giannini, Giulia</creator><general>John Wiley & Sons, Inc</general><scope>24P</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TK</scope><scope>7U7</scope><scope>C1K</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-0499-3236</orcidid><orcidid>https://orcid.org/0000-0002-3633-8818</orcidid></search><sort><creationdate>202501</creationdate><title>Evaluating gait and postural responses to subthalamic stimulation and levodopa: A prospective study using wearable technology</title><author>Cani, Ilaria ; D'Ascanio, Ilaria ; Baldelli, Luca ; Lopane, Giovanna ; Ranciati, Saverio ; Mantovani, Paolo ; Conti, Alfredo ; Cortelli, Pietro ; Calandra‐Buonaura, Giovanna ; Chiari, Lorenzo ; Palmerini, Luca ; Giannini, Giulia</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c2430-eb50bec2819df90988732f67205ffa21631637c682f38a2b434a09e307ce9f613</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2025</creationdate><topic>Aged</topic><topic>Antiparkinson Agents - therapeutic use</topic><topic>Basal ganglia</topic><topic>Deep brain stimulation</topic><topic>Deep Brain Stimulation - methods</topic><topic>Effectiveness</topic><topic>Evaluation</topic><topic>Female</topic><topic>Gait</topic><topic>Gait - drug effects</topic><topic>Gait - physiology</topic><topic>Gait Disorders, Neurologic - etiology</topic><topic>Gait Disorders, Neurologic - therapy</topic><topic>Gait recognition</topic><topic>Ganglia</topic><topic>Humans</topic><topic>inertial measurement units</topic><topic>kinematic analysis</topic><topic>Levodopa</topic><topic>Levodopa - administration & dosage</topic><topic>Levodopa - pharmacology</topic><topic>Levodopa - therapeutic use</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Movement disorders</topic><topic>Neurodegenerative diseases</topic><topic>neuromodulation</topic><topic>Parameters</topic><topic>Parkinson Disease - drug therapy</topic><topic>Parkinson Disease - therapy</topic><topic>Parkinson's disease</topic><topic>Postural Balance - drug effects</topic><topic>Postural Balance - physiology</topic><topic>Posture</topic><topic>Posture - physiology</topic><topic>Prospective Studies</topic><topic>Solitary tract nucleus</topic><topic>Stimulation</topic><topic>Subthalamic Nucleus - drug effects</topic><topic>Surgery</topic><topic>Turning gait</topic><topic>Variability</topic><topic>Wearable Electronic Devices</topic><topic>Wearable technology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Cani, Ilaria</creatorcontrib><creatorcontrib>D'Ascanio, Ilaria</creatorcontrib><creatorcontrib>Baldelli, Luca</creatorcontrib><creatorcontrib>Lopane, Giovanna</creatorcontrib><creatorcontrib>Ranciati, Saverio</creatorcontrib><creatorcontrib>Mantovani, Paolo</creatorcontrib><creatorcontrib>Conti, Alfredo</creatorcontrib><creatorcontrib>Cortelli, Pietro</creatorcontrib><creatorcontrib>Calandra‐Buonaura, Giovanna</creatorcontrib><creatorcontrib>Chiari, Lorenzo</creatorcontrib><creatorcontrib>Palmerini, Luca</creatorcontrib><creatorcontrib>Giannini, Giulia</creatorcontrib><collection>Wiley-Blackwell Open Access Collection</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Neurosciences Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of neurology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Cani, Ilaria</au><au>D'Ascanio, Ilaria</au><au>Baldelli, Luca</au><au>Lopane, Giovanna</au><au>Ranciati, Saverio</au><au>Mantovani, Paolo</au><au>Conti, Alfredo</au><au>Cortelli, Pietro</au><au>Calandra‐Buonaura, Giovanna</au><au>Chiari, Lorenzo</au><au>Palmerini, Luca</au><au>Giannini, Giulia</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Evaluating gait and postural responses to subthalamic stimulation and levodopa: A prospective study using wearable technology</atitle><jtitle>European journal of neurology</jtitle><addtitle>Eur J Neurol</addtitle><date>2025-01</date><risdate>2025</risdate><volume>32</volume><issue>1</issue><spage>e16580</spage><epage>n/a</epage><pages>e16580-n/a</pages><issn>1351-5101</issn><issn>1468-1331</issn><eissn>1468-1331</eissn><abstract>Background
The efficacy of subthalamic stimulation on axial signs of Parkinson's disease (PD) is debated in the literature. This study delves into the dynamic interplay of gait and posture, specifically probing their nuanced response to subthalamic stimulation and levodopa.
Methods
We used wearable sensor technology to examine alterations in the spatiotemporal parameters of gait and posture in individuals with PD before and 6 months after subthalamic deep brain stimulation (STN‐DBS) surgery. Thirty‐three subjects with PD were evaluated in two pre‐operative and four post‐operative conditions comprising OFF/ON medication and stimulation states. Standardized response mean (SRM) values were calculated to assess treatment responsiveness.
Results
Significant improvements in spatiotemporal gait parameters, including speed, stride length, cadence, and turning, were observed following STN‐DBS surgery. Quantitatively, stimulation outperformed levodopa in enhancing gait speed, stride length, and turning, as indicated by SRM. Levodopa moderately improved stride time variability and asymmetry, while stimulation alone demonstrated limited efficacy. Postural parameters exhibited minimal change following STN‐DBS, although stimulation showed a slight benefit in certain postural aspects.
Conclusion
Our findings suggest positive effects of stimulation and levodopa on gait and postural parameters, with STN‐DBS demonstrating superior efficacy in enhancing gait speed, stride length, and turning. However, gait variability remains unaddressed by current therapies, highlighting the need for novel treatments targeting regions beyond the basal ganglia.</abstract><cop>England</cop><pub>John Wiley & Sons, Inc</pub><pmid>39702816</pmid><doi>10.1111/ene.16580</doi><tpages>12</tpages><orcidid>https://orcid.org/0000-0002-0499-3236</orcidid><orcidid>https://orcid.org/0000-0002-3633-8818</orcidid><oa>free_for_read</oa></addata></record> |
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| source | Wiley-Blackwell Open Access Collection; PubMed Central |
| subjects | Aged Antiparkinson Agents - therapeutic use Basal ganglia Deep brain stimulation Deep Brain Stimulation - methods Effectiveness Evaluation Female Gait Gait - drug effects Gait - physiology Gait Disorders, Neurologic - etiology Gait Disorders, Neurologic - therapy Gait recognition Ganglia Humans inertial measurement units kinematic analysis Levodopa Levodopa - administration & dosage Levodopa - pharmacology Levodopa - therapeutic use Male Middle Aged Movement disorders Neurodegenerative diseases neuromodulation Parameters Parkinson Disease - drug therapy Parkinson Disease - therapy Parkinson's disease Postural Balance - drug effects Postural Balance - physiology Posture Posture - physiology Prospective Studies Solitary tract nucleus Stimulation Subthalamic Nucleus - drug effects Surgery Turning gait Variability Wearable Electronic Devices Wearable technology |
| title | Evaluating gait and postural responses to subthalamic stimulation and levodopa: A prospective study using wearable technology |
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