Article

Postural instability is a major source of disability in idiopathic
Parkinson's disease (IPD). Deep brain stimulation of the globus pallidus internus
(GPI-DBS) improves clinician-rated balance control but there have been few
quantitative studies of its interactive effects with levodopa (L-DOPA).
The purpose of this study was to compare the short-term and interactive effects of
GPI-DBS and L-DOPA on objective measures of postural stability in patients with
longstanding IPD. METHODS: Static and dynamic posturography during a whole-body
leaning task were performed in 10 IPD patients with bilateral GPI stimulators
under the following conditions: untreated (OFF); L-DOPA alone; DBS alone;
DBS+L-DOPA, and in 9 healthy Control subjects. Clinical status was assessed using
the UPDRS and AIMS Dyskinesia Scale. RESULTS: Static sway was greater in IPD
patients in the OFF state compared to the Control subjects and was further
increased by L-DOPA and reduced by GPI-DBS. In the dynamic task, L-DOPA had a
greater effect than GPI-DBS on improving Start Time, but reduced the spatial
accuracy and directional control of the task. When the two therapies were
combined, GPI-DBS prevented the L-DOPA induced increase in static sway and
improved the accuracy of the dynamic task. CONCLUSION: The findings demonstrate
GPI-DBS and L-DOPA have differential effects on temporal and spatial aspects of
postural control in IPD and that GPI-DBS counteracts some of the adverse effects
of L-DOPA. Further studies on larger numbers of patients with GPI stimulators are
required to confirm these findings and to clarify the contribution of dyskinesias
to impaired dynamic postural control.
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Langue : ANGLAIS