Carine Karachi1, Florence Cormier-Dequaire2, David Grabli2, Brian Lau3, Hayat Belaid1, Soledad Navarro4, Marie Vidailhet2, Eric Bardinet5, Sara Fernandez-Vidal5, Marie-Laure Welter6. 1. Université Pierre et Marie Curie-Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle épiniere (CRICM), UMR-S975, Paris, France; INSERM, U975, Paris, France; CNRS, UMR 7225, CR-ICM, Paris, France; Neurosurgery Department, APHP, Hôpitaux Universitaires Pitié-Salpêtrière/Charles Foix, Paris, France. 2. Université Pierre et Marie Curie-Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle épiniere (CRICM), UMR-S975, Paris, France; INSERM, U975, Paris, France; CNRS, UMR 7225, CR-ICM, Paris, France; Neurology Department, APHP, Hôpitaux Universitaires Pitié-Salpêtrière/Charles Foix, Paris, France. 3. Université Pierre et Marie Curie-Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle épiniere (CRICM), UMR-S975, Paris, France; INSERM, U975, Paris, France; CNRS, UMR 7225, CR-ICM, Paris, France. 4. Neurosurgery Department, APHP, Hôpitaux Universitaires Pitié-Salpêtrière/Charles Foix, Paris, France. 5. Université Pierre et Marie Curie-Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle épiniere (CRICM), UMR-S975, Paris, France; INSERM, U975, Paris, France; CNRS, UMR 7225, CR-ICM, Paris, France; Centre de Neuroimagerie de Recherche de l'Institut du Cerveau et de la Moelle épinière (CENIR ICM), Paris, France. 6. Université Pierre et Marie Curie-Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle épiniere (CRICM), UMR-S975, Paris, France; INSERM, U975, Paris, France; CNRS, UMR 7225, CR-ICM, Paris, France; Neurophysiology Department, CHU Rouen, Normandie University, Rouen, France. Electronic address: marielaure.welter@icm-institute.org.
Abstract
INTRODUCTION: Freezing of gait (FOG) and falls are the most disabling motor symptoms in Parkinson's disease (PD) patients. The effects of subthalamic deep-brain-stimulation (STN-DBS) on FOG and falls are still a matter of controversy, and factors contributing to their outcome have yet to be defined. METHODS: We examined the relationship between FOG and falls after STN-DBS and preoperative clinical features, MRI voxel-based-morphometry (VBM) analysis and statistical mapping of electrode locations. RESULTS: 331 patients (age at surgery = 57.7 ± 8.4 years; disease duration = 12.5 ± 5 years) were included in the final analysis, with VBM analysis in 151 patients. After surgery, FOG was aggravated in 93 patients and falls in 75 patients. After surgery, FOG severity was related to its level before surgery without dopaminergic treatment, the dopaminergic treatment dosage and severity of motor fluctuations after surgery; and falls severity to lower postoperative cognitive performance. VBM analyses revealed that, relative to other patient groups, patients with FOG worsening had putamen grey matter density decrease, and fallers patients a left postcentral gyrus atrophy. The best effects of STN-DBS on FOG and falls were associated with the location of contacts within the STN, but no specific location related to aggravation. CONCLUSIONS: FOG and falls are reduced after STN-DBS in about 1/3 of patients, with the best effects obtained for electrodes located within the STN. Clinicians should be aware that, after STN-DBS, FOG severity is related to preoperative FOG severity whatever its dopa-sensitivity; and falls to lower postoperative cognitive performance; and atrophy of cortico-subcortical brain areas.
INTRODUCTION: Freezing of gait (FOG) and falls are the most disabling motor symptoms in Parkinson's disease (PD) patients. The effects of subthalamic deep-brain-stimulation (STN-DBS) on FOG and falls are still a matter of controversy, and factors contributing to their outcome have yet to be defined. METHODS: We examined the relationship between FOG and falls after STN-DBS and preoperative clinical features, MRI voxel-based-morphometry (VBM) analysis and statistical mapping of electrode locations. RESULTS: 331 patients (age at surgery = 57.7 ± 8.4 years; disease duration = 12.5 ± 5 years) were included in the final analysis, with VBM analysis in 151 patients. After surgery, FOG was aggravated in 93 patients and falls in 75 patients. After surgery, FOG severity was related to its level before surgery without dopaminergic treatment, the dopaminergic treatment dosage and severity of motor fluctuations after surgery; and falls severity to lower postoperative cognitive performance. VBM analyses revealed that, relative to other patient groups, patients with FOG worsening had putamen grey matter density decrease, and fallers patients a left postcentral gyrus atrophy. The best effects of STN-DBS on FOG and falls were associated with the location of contacts within the STN, but no specific location related to aggravation. CONCLUSIONS:FOG and falls are reduced after STN-DBS in about 1/3 of patients, with the best effects obtained for electrodes located within the STN. Clinicians should be aware that, after STN-DBS, FOG severity is related to preoperative FOG severity whatever its dopa-sensitivity; and falls to lower postoperative cognitive performance; and atrophy of cortico-subcortical brain areas.
Authors: Daniel Weiss; Anna Schoellmann; Michael D Fox; Nicolaas I Bohnen; Stewart A Factor; Alice Nieuwboer; Mark Hallett; Simon J G Lewis Journal: Brain Date: 2020-01-01 Impact factor: 13.501
Authors: Andrea Kelemen; László Halász; Muthuraman Muthuraman; Loránd Erőss; Péter Barsi; Dénes Zádori; Bence Laczó; Dávid Kis; Péter Klivényi; Gábor Fekete; László Bognár; Dániel Bereczki; Gertrúd Tamás Journal: Front Neurol Date: 2022-09-26 Impact factor: 4.086
Authors: Alessandro Zampogna; Francesco Cavallieri; Francesco Bove; Antonio Suppa; Anna Castrioto; Sara Meoni; Pierre Pélissier; Emmanuelle Schmitt; Amélie Bichon; Eugénie Lhommée; Andrea Kistner; Stephan Chabardès; Eric Seigneuret; Valerie Fraix; Elena Moro Journal: NPJ Parkinsons Dis Date: 2022-09-24