Postural stability under globus pallidus internus stimulation for dystonia. Issue 12 (December 2015)

• Record Type: Journal Article
• Authors: Brecl Jakob, Gregor; Pelykh, Olena; Košutzká, Zuzana; Pirtošek, Zvezdan; Trošt, Maja; Ilmberger, Joseph; Valkovic, Peter; Mehrkens, Jan H.; Bötzel, Kai
• Is Part Of: Clinical neurophysiology. Volume 126:Issue 12(2015:Dec.)
• Page Start: 2299
• Page End: 2305
• Publication Date: 2015-12
• Subjects: Dystonia -- Globus pallidus -- Deep brain stimulation -- Postural balance; Neurophysiology -- Periodicals; Electroencephalography -- Periodicals; Electromyography -- Periodicals; Neurology -- Periodicals; 612.8
• DOI: 10.1016/j.clinph.2015.01.022
• Languages: English
• ISSNs: 1388-2457

Abstract

Highlights: Deep brain stimulation for dystonia can cause postural disequilibrium as a side-effect. We measured postural reflexes in patients with focus on the effect of stimulation. In dystonia globus pallidus internus stimulation causes a decline in postural stability. Abstract: Objective: Deep brain stimulation of the globus pallidus internus (GPi-DBS) is an efficient and safe treatment for medically refractory dystonia. However, recent studies reported gait problems, falls and bradykinesia in patients after the DBS procedure. The aim of this study was to quantify the effect of GPi-DBS on postural performance in patients with cranio-cervical dystonia. Methods: Thirteen patients with focal/segmental dystonia and GPi-DBS participated in the study. We performed two postural tests (pull test and push and release test) in on- and off-stimulation conditions and recorded the movements of the patients with inertial sensors. Results: Under stimulation patients exhibited a higher number of steps ( p = 0.015), reduced first step length ( p = 0.011) and lower stepping velocity ( p = 0.001), compared to off stimulation. We observed a higher number of steps in the push and release test compared to the pull test ( p = 0.038). The interaction between stimulation condition and test type was significant ( p = 0.027). Conclusions: The velocity and amplitude of postural reactions are compromised by GPi-DBS in patients with cranio-cervical dystonia. Significance: This information corresponds to patient's reports of falls and postural instability after GPi-DBS. Pre-operatively, patients should be informed about the possibility of the occurrence of such phenomena.