Article

Following the hypothesis that thalamic deep brain stimulation improves ataxia in
patients with essential tremor by modulating the cerebello-thalamo-cortical
pathway, we examined the joint kinematics of lower limbs during uninterrupted
gait in eleven patients who have been treated with bilateral thalamic stimulation
for 24.7+/-20.3 months. Patients were assessed under routine chronic stimulation,
supra-therapeutic amplitude, and off stimulation by means of an infrared movement
analysis system while walking on a treadmill. Chronic thalamic DBS normalized the
highly variable excursion throughout the gait cycle that characterized the
subgroup of patients with longest disease duration. Supratherapeutic thalamic DBS
amplitude did not reproduce such improvements while,
more importantly, it induced
ataxic changes of joint excursion. The normalization of kinematic abnormalities
argues against the hypothesis of a cerebellar neurodegeneration in ET. Moreover,
these results suggest that the beneficial effect of thalamic DBS on ataxic
symptoms is limited to a narrow therapeutic window.
CI - Copyright (c) 2012 Elsevier B.V. All rights reserved.

Langue : ANGLAIS