Effets de la stimulation du noyau subthalamique sur la marche et l’équilibre dans la maladie de Parkinson : approche clinique, cinématique et posturographique

Abstract : Introduction: the localization of the subthalamic nucleus (STN) can be estimated by algorithms based on new imaging techniques allowing deep brain stimulation (DBS) without intraoperative testing under general anaesthesia. However, we still need to establish if this procedure induces similar benefits on axial symptoms than those observed in patients operated under local anaesthesia. Our aim was to assess the effects of STN DBS under general anaesthesia on gait and balance in patients with Parkinson’s disease. Methods: clinical approach was based on the UPDRS III scale, the gait and postural stability items and an axial composite score. Kinematic analysis of gait focused on velocity, cadence, double-support time, step length, trunk velocity and displacement. Balance was assessed on posturography and focused on the area containing 95% of the centre of pressure (CoP) displacement, the CoP length and velocity displacements. Results: 18 patients were included. STN DBS improved clinical scores except the postural stability item. Trunk velocity and displacement were significantly increased during gait and the mediolateral displacement of the CoP was decreased. These improvements were correlated with preoperative improvement of UPDRS III after levodopa intake. Discussion: compared to literature data, patients who had asleep surgery demonstrated less improvements of their axial symptoms at 3 months than those who had awake surgery. These initial findings need to be confirmed during a longer period of observation and by comparing them to data from patients who underwent awake surgery in the same centre. Conclusion: STN DBS under general anaesthesia has not demonstrated an equivalent benefit on gait and balance compared to awake surgery.
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Master Thesis
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Lidia Afonso Delgado. Effets de la stimulation du noyau subthalamique sur la marche et l’équilibre dans la maladie de Parkinson : approche clinique, cinématique et posturographique. Médecine humaine et pathologie. 2018. ⟨dumas-02088861⟩

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