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The effects of high frequency subthalamic stimulation on balance performance and fear of falling in patients with Parkinson's disease.

Nilsson, Maria H LU ; Fransson, Per-Anders LU ; Jarnlo, Gun-Britt LU ; Magnusson, Måns LU and Rehncrona, Stig LU (2009) In Journal of NeuroEngineering and Rehabilitation 6(Apr 30).
Abstract
BACKGROUND: Balance impairment is one of the most distressing symptoms in Parkinson's disease (PD) even with pharmacological treatment (levodopa). A complementary treatment is high frequency stimulation in the subthalamic nucleus (STN). Whether STN stimulation improves postural control is under debate. The aim of this study was to explore the effects of STN stimulation alone on balance performance as assessed with clinical performance tests, subjective ratings of fear of falling and posturography. METHODS: Ten patients (median age 66, range 59-69 years) with bilateral STN stimulation for a minimum of one year, had their anti-PD medications withdrawn overnight. Assessments were done both with the STN stimulation turned OFF and ON (start... (More)
BACKGROUND: Balance impairment is one of the most distressing symptoms in Parkinson's disease (PD) even with pharmacological treatment (levodopa). A complementary treatment is high frequency stimulation in the subthalamic nucleus (STN). Whether STN stimulation improves postural control is under debate. The aim of this study was to explore the effects of STN stimulation alone on balance performance as assessed with clinical performance tests, subjective ratings of fear of falling and posturography. METHODS: Ten patients (median age 66, range 59-69 years) with bilateral STN stimulation for a minimum of one year, had their anti-PD medications withdrawn overnight. Assessments were done both with the STN stimulation turned OFF and ON (start randomized). In both test conditions, the following were assessed: motor symptoms (descriptive purposes), clinical performance tests, fear of falling ratings, and posturography with and without vibratory proprioceptive disturbance. RESULTS: STN stimulation alone significantly (p = 0.002) increased the scores of the Berg balance scale, and the median increase was 6 points. The results of all timed performance tests, except for sharpened Romberg, were significantly (p <or= 0.016) improved. The patients rated their fear of falling as less severe, and the total score of the Falls-Efficacy Scale(S) increased (p = 0.002) in median with 54 points. All patients completed posturography when the STN stimulation was turned ON, but three patients were unable to do so when it was turned OFF. The seven patients with complete data showed no statistical significant difference (p values >or= 0.109) in torque variance values when comparing the two test situations. This applied both during quiet stance and during the periods with vibratory stimulation, and it was irrespective of visual input and sway direction. CONCLUSION: In this sample, STN stimulation alone significantly improved the results of the clinical performance tests that mimic activities in daily living. This improvement was further supported by the patients' ratings of fear of falling, which were less severe with the STN stimulation turned ON. Posturography could not be performed by three out of the ten patients when the stimulation was turned OFF. The posturography results of the seven patients with complete data showed no significant differences due to STN stimulation. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
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in
Journal of NeuroEngineering and Rehabilitation
volume
6
issue
Apr 30
publisher
BioMed Central
external identifiers
  • WOS:000266747500001
  • PMID:19405954
  • Scopus:66249104675
ISSN
1743-0003
DOI
10.1186/1743-0003-6-13
language
English
LU publication?
yes
id
a01acbbc-c7e5-4882-a3f9-e774c4d36507 (old id 1412805)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/19405954?dopt=Abstract
date added to LUP
2009-06-01 09:07:21
date last changed
2016-10-13 04:28:08
@misc{a01acbbc-c7e5-4882-a3f9-e774c4d36507,
  abstract     = {BACKGROUND: Balance impairment is one of the most distressing symptoms in Parkinson's disease (PD) even with pharmacological treatment (levodopa). A complementary treatment is high frequency stimulation in the subthalamic nucleus (STN). Whether STN stimulation improves postural control is under debate. The aim of this study was to explore the effects of STN stimulation alone on balance performance as assessed with clinical performance tests, subjective ratings of fear of falling and posturography. METHODS: Ten patients (median age 66, range 59-69 years) with bilateral STN stimulation for a minimum of one year, had their anti-PD medications withdrawn overnight. Assessments were done both with the STN stimulation turned OFF and ON (start randomized). In both test conditions, the following were assessed: motor symptoms (descriptive purposes), clinical performance tests, fear of falling ratings, and posturography with and without vibratory proprioceptive disturbance. RESULTS: STN stimulation alone significantly (p = 0.002) increased the scores of the Berg balance scale, and the median increase was 6 points. The results of all timed performance tests, except for sharpened Romberg, were significantly (p &lt;or= 0.016) improved. The patients rated their fear of falling as less severe, and the total score of the Falls-Efficacy Scale(S) increased (p = 0.002) in median with 54 points. All patients completed posturography when the STN stimulation was turned ON, but three patients were unable to do so when it was turned OFF. The seven patients with complete data showed no statistical significant difference (p values &gt;or= 0.109) in torque variance values when comparing the two test situations. This applied both during quiet stance and during the periods with vibratory stimulation, and it was irrespective of visual input and sway direction. CONCLUSION: In this sample, STN stimulation alone significantly improved the results of the clinical performance tests that mimic activities in daily living. This improvement was further supported by the patients' ratings of fear of falling, which were less severe with the STN stimulation turned ON. Posturography could not be performed by three out of the ten patients when the stimulation was turned OFF. The posturography results of the seven patients with complete data showed no significant differences due to STN stimulation.},
  author       = {Nilsson, Maria H and Fransson, Per-Anders and Jarnlo, Gun-Britt and Magnusson, Måns and Rehncrona, Stig},
  issn         = {1743-0003},
  language     = {eng},
  number       = {Apr 30},
  publisher    = {ARRAY(0xaa7f7b8)},
  series       = {Journal of NeuroEngineering and Rehabilitation},
  title        = {The effects of high frequency subthalamic stimulation on balance performance and fear of falling in patients with Parkinson's disease.},
  url          = {http://dx.doi.org/10.1186/1743-0003-6-13},
  volume       = {6},
  year         = {2009},
}