Skip to main content
SpringerLink
Log in

Subthalamic nucleus stimulation and levodopa-resistant postural instability in Parkinson's disease

  • ORIGINAL COMMUNICATION
  • Published:
Journal of Neurology Aims and scope Submit manuscript

Abstract

We examined the effect of bilateral subthalamic nucleus stimulation on levodopa-resistant balance impairment in 14 patients with Parkinson's disease and 18 matched controls. Instability was quantitatively assessed using standardized multidirectional dynamic posturography. Patients were tested after taking a suprathreshold dose of levodopa, both with stimulators turned on and off. Patients with stimulators turned off were more unstable than controls following backward directed perturbations. Overall, patients' instability did not improve with STN stimulation, and considerable inter-individual variability was noted. Of note, marked levodopa- resistant axial motor symptoms before surgery correlated with an adverse treatment effect. We conclude that STN stimulation does not alleviate levodopa-resistant postural instability in Parkinson's disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Allum JH, Carpenter MG, Honegger F, Adkin AL, Bloem BR (2002) Age-dependent variations in the directional sensitivity of balance corrections and compensatory arm movements in man. J Physiol 542:643–663

    Article  PubMed  CAS  Google Scholar 

  2. Bakker M, Esselink RA, Munneke M, Limousin-Dowsey P, Speelman HD, Bloem BR (2004) Effects of stereotactic neurosurgery on postural instability and gait in Parkinson's disease. Mov Disord 19:1092–1099

    Article  PubMed  Google Scholar 

  3. Bejjani BP, Gervais D, Arnulf I, Papadopoulos S, Demeret S, Bonnet AM, Cornu P, Damier P, Agid Y (2000) Axial parkinsonian symptoms can be improved: the role of levodopa and bilateral subthalamic stimulation. J Neurol Neurosurg Psychiatry 68:595–600

    Article  PubMed  CAS  Google Scholar 

  4. Bloem BR, Bhatia KP (2004) Gait and balance in basal ganglia disorders. In: Bronstein AM, Brandt T, Woollacott MH, Nutt JG (eds) Clinical disorders of balance, posture and gait. Arnold, London, pp 173–206

  5. Bloem BR, Visser JE, Allum JH (2003) Posturography. In: Hallett M (ed) Movement Disorders – Handbook of Clinical Neurophysiology. Elsevier, pp 295–336

  6. Carpenter MG, Allum JH, Honegger F, Adkin AL, Bloem BR (2004) Postural abnormalities to multidirectional stance perturbations in Parkinson's disease. J Neurol Neurosurg Psychiatry 75:1245–1254

    Article  PubMed  CAS  Google Scholar 

  7. Carpenter MG, Thorstensson A, Cresswell AG (2005) Deceleration affects anticipatory and reactive components of triggered postural responses. Exp Brain Res 167:433–445

    Article  PubMed  Google Scholar 

  8. Charles PD, Van Blercom N, Krack P, Lee SL, Xie J, Besson G, Benabid AL, Pollak P (2002) Predictors of effective bilateral subthalamic nucleus stimulation for PD. Neurology 59:932–934

    PubMed  CAS  Google Scholar 

  9. Colnat-Coulbois S, Gauchard GC, Maillard L, Barroche G, Vespignani H, Auque J, Perrin PP (2005) Bilateral subthalamic nucleus stimulation improves balance control in Parkinson's disease. J Neurol Neurosurg Psychiatry 76:780–787

    Article  PubMed  CAS  Google Scholar 

  10. Esselink RA, de Bie RM, de Haan RJ, Lenders MW, Nijssen PC, Staal MJ, Smeding HM, Schuurman PR, Bosch DA, Speelman JD (2004) Unilateral pallidotomy versus bilateral subthalamic nucleus stimulation in PD: a randomized trial. Neurology 62:201–207

    PubMed  CAS  Google Scholar 

  11. Goetz CG, Stebbins GT, Shale HM, Lang AE, Chernik DA, Chmura TA, Ahlskog JE, Dorflinger EE (1994) Utility of an objective dyskinesia rating scale for Parkinson's disease: interand intrarater reliability assessment. Mov Disord 9:390–394

    Article  PubMed  CAS  Google Scholar 

  12. Horak FB, Dimitrova D, Nutt JG (2005) Direction-specific postural instability in subjects with Parkinson's disease. Exp Neurol 193:504–521

    Article  PubMed  Google Scholar 

  13. Hughes AJ, Daniel SE, Kilford L, Lees AJ (1992) Accuracy of clinical diagnosis of idiopathic Parkinson's disease: a clinico-pathological study of 100 cases. J Neurol Neurosurg Psychiatry 55:181–184

    Article  PubMed  CAS  Google Scholar 

  14. Krack P, Batir A, Van Blercom N, Chabardes S, Fraix V, Ardouin C, Koudsie A, Limousin PD, Benazzouz A, LeBas JF, Benabid AL, Pollak P (2003) Five-year follow-up of bilateral stimulation of the subthalamic nucleus in advanced Parkinson's disease. N Engl J Med 349:1925–1934

    Article  PubMed  CAS  Google Scholar 

  15. Krack P, Pollak P, Limousin P, Hoffmann D, Xie J, Benazzouz A, Benabid AL (1998) Subthalamic nucleus or internal pallidal stimulation in young onset Parkinson's disease. Brain 121 (Pt 3):451–457

    Article  PubMed  Google Scholar 

  16. Limousin P, Krack P, Pollak P, Benazzouz A, Ardouin C, Hoffmann D, Benabid AL (1998) Electrical stimulation of the subthalamic nucleus in advanced Parkinson's disease. N Engl J Med 339:1105–1111

    Article  PubMed  CAS  Google Scholar 

  17. Maurer C, Mergner T, Xie J, Faist M, Pollak P, Lucking CH (2003) Effect of chronic bilateral subthalamic nucleus (STN) stimulation on postural control in Parkinson's disease. Brain 126:1146–1163

    Article  PubMed  CAS  Google Scholar 

  18. Mazzone P, Lozano A, Stanzione P, Galati S, Scarnati E, Peppe A, Stefani A (2005) Implantation of human pedunculopontine nucleus: a safe and clinically relevant target in Parkinson's disease. Neuroreport 16:1877–1881

    Article  PubMed  Google Scholar 

  19. Munhoz RP, Li JY, Kurtinecz M, Piboolnurak P, Constantino A, Fahn S, Lang AE (2004) Evaluation of the pull test technique in assessing postural instability in Parkinson's disease. Neurology 62:125–127

    PubMed  CAS  Google Scholar 

  20. Obeso JA, Olanow CW, Rodriguez- Oroz MC, Krack P, Kumar R, lang AE, for the Deep-brain stimulation for Parkinson's disease study group (2001) Deep-brain stimulation of the subthalamic nucleus or the pars interna of the globus pallidus in Parkinson's disease. N Engl J Med 345:956–963

    Article  Google Scholar 

  21. Plaha P, Gill SS (2005) Bilateral deep brain stimulation of the pedunculopontine nucleus for Parkinson's disease. Neuroreport 16:1883–1887

    Article  PubMed  Google Scholar 

  22. Rocchi L, Chiari L, Cappello A, Gross A, Horak FB (2004) Comparison between subthalamic nucleus and globus pallidus internus stimulation for postural performance in Parkinson's disease. Gait Posture 19:172–183

    Article  PubMed  Google Scholar 

  23. Visser JE, Bloem BR (2005) Role of the basal ganglia in balance control. Neural Plast 12:161–174

    Article  PubMed  Google Scholar 

  24. Volkmann J, Sturm V, Weiss P, Kappler J, Voges J, Koulousakis A, Lehrke R, Hefter H, Freund HJ (1998) Bilateral high-frequency stimulation of the internal globus pallidus in advanced Parkinson's disease. Ann Neurol 44:953–961

    Article  PubMed  CAS  Google Scholar 

  25. Vrancken AM, Allum JH, Peller M, Visser JE, Esselink RA, Speelman JD, Siebner HR, Bloem BR (2005) Effect of bilateral subthalamic nucleus stimulation on balance and finger control in Parkinson's disease. J Neurol 252:1487–1494

    Article  PubMed  CAS  Google Scholar 

  26. Welter ML, Houeto JL, Tezenas du MS, Mesnage V, Bonnet AM, Pillon B, Arnulf I, Pidoux B, Dormont D, Cornu P, Agid Y (2002) Clinical predictive factors of subthalamic stimulation in Parkinson's disease. Brain 125:575–583

    Article  PubMed  CAS  Google Scholar 

  27. Winter DA, Patla AE, Ishac M, Gage WH (2003) Motor mechanisms of balance during quiet standing. J Electromyogr Kinesiol 13:49–56

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Dept. of Neurology (HP 935), Radboud University Nijmegen Medical Centre, 9101, 6500, HB Nijmegen, The Netherlands

    J. E. Visser MD, MSc, R. A. Esselink MD & B. R. Bloem MD, PhD

  2. Dept. of Otorhinolaryngology, University Hospital Basel, Switzerland

    J. E. Visser MD, MSc, J. H. J. Allum DSc & M. G. Carpenter PhD

  3. School of Human Kinetics, University of British Columbia, Vancouver, Canada

    M. G. Carpenter PhD

  4. Dept. of Geriatrics, Radboud University Nijmegen Medical Centre, The Netherlands

    R. A. Esselink MD

  5. Dept. of Neurology, Academic Medical Center, University Hospital of Amsterdam, The Netherlands

    J. D. Speelman MD, PhD

  6. Dept. of Epidemiology and Biostatistics, Radboud University Nijmegen Medical Centre, The Netherlands

    G. F. Borm PhD

Authors
  1. J. E. Visser MD, MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. H. J. Allum DSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. G. Carpenter PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. R. A. Esselink MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. J. D. Speelman MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. G. F. Borm PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. B. R. Bloem MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to B. R. Bloem MD, PhD.

Additional information

The authors have no relevant financial interests in the manuscript.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Visser, J.E., Allum, J.H.J., Carpenter, M.G. et al. Subthalamic nucleus stimulation and levodopa-resistant postural instability in Parkinson's disease. J Neurol 255, 205–210 (2008). https://doi.org/10.1007/s00415-008-0636-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00415-008-0636-x

Key words

Search

Navigation