Article

Deep brain stimulation (DBS) of the globus pallidus internus (GPi)
has been established as an effective and safe treatment for dystonia. In general,
side effects are rare, but there is increasing evidence that GPi DBS in dystonia
can induce hypokinetic symptoms like micrographia or freezing of gait. We aimed
to evaluate and quantify possible changes of gait following bilateral chronic GPi
DBS for dystonia by computerized gait analyses. METHODS: We prospectively
performed computerized gait analysis in ten consecutive patients (mean age
57.8+/-14.3 years) with segmental dystonia but without involvement of lower trunk
or legs who were treated with bilateral GPi DBS. Using pressure sensitive
insoles, several parameters were measured preoperatively (pre-OP) and at a median
of 7 months postoperatively. RESULTS: The mean step length significantly
decreased from 60.0+/-6.9cm pre-OP to 54.3+/-6.4cm with GPi DBS (p<0.01). Due to
only small changes of walking distance and gait velocity, the cadence
correspondingly increased from 105.6+/-9.2 steps/min to 111.3+/-11.4 steps/min
(p<0.05). More importantly, the variance of several gait parameters significantly
decreased postoperatively. CONCLUSIONS: In patients with segmental dystonia,
chronic DBS of the posteroventral lateral GPi is associated with only mild
hypokinesia of gait, but with a relevant decrease in gait variability. Given
other recently reported hypokinetic effects of GPi DBS for dystonia and recent
results of electrophysiological coherence studies, these findings support the
hypothesis of a general alteration of neuronal activity in
striato-pallido-thalamo-cortical motor pathways following chronic stimulation of
the posteroventral lateral GPi.
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Langue : ANGLAIS