THS durch segmentale Elektroden im STN bei Personen mit Morbus Parkinson—Auswirkungen auf axiale Symptome,Deep brain stimulation via segmented leads in the subthalamic nucleus in Parkinson's disease-impact on axial symptoms

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Erscheinungsjahr:
2019
Medientyp:
Text
Schlagworte:
  • dk/atira/pure/publikationen_lom_relevant/publikation_ist_nicht_scoring_relevant
  • Hamburg Center of Neuroscience (HCNS)
  • dk/atira/pure/keywords/workgroup/129
  • SFB 936 "Multi-Side-Communication in the Brain" (129)
Beschreibung:
  • Introduction: Axial symptoms such as gait deficits, freezing of gait and postural instability have a major impact on activities of daily living and quality of life in people with Parkinson’s disease (PD). Conventional omnidirectional deep brain stimulation of the subthalamic nucleus (STN-DBS) has been shown to improve levodopa- responsive aspects of the Parkinsonian gait disorder such as gait hypokinesia although with considerable residual temporal gait deficits and freezing of gait. New technological opportunities with segmented lead stimulation has been demonstrated to increase the therapeutic window in terms of general motor symptoms, however the effect of directed stimulation on particular axial symptoms and gait is unknown.
    Target: To compare omnidirectional and directed STN-DBS (anterior, postero-medial or postero-lateral) in PD patients.
    Methods: The primary outcomes of the prospective, randomised, double-blind, clinical trial were acute changes of spatial-temporal gait parameters at different walking conditions, i.e. preferred speed, maximal speed and during adapted gait. These parameters were captured by the GAITRITEÒ system with different stimulation modes, i.e. ring-mode stimulation, stimulation of single segments (anterior, postero-medial, postero-lateral) and with the stimulator turned off on a single day in the medication off-state. Secondary
    outcomes were changes of freezing of gait (Ziegler Course), motor- symptoms (MDS-UPDRS motor part III, with focus on axial PIGD subitems), static and dynamic balance abilities (Berg Balance score— short-version).
    Results: Preliminary results determine the effect of DBS in the STN on spatial gait parameters, freezing of gait, balance abilities and motor symptoms. The difference of conventional ring-mode DBS compared to each single segment (anterior, postero-medial, postero-lateral) seems to vary between outcome measurements with prefer- able findings for stimulation in the antero-medial direction. Conclusion: Preliminary results support the positive impact of STN- DBS on axial symptoms in PD patients. It is proposed that uniseg-mental stimulation might take advantage of the somatotopic organisation of STN sub territories for further improvement of gait and postural stability.
Lizenz:
  • info:eu-repo/semantics/closedAccess
Quellsystem:
Forschungsinformationssystem des UKE

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oai:pure.atira.dk:publications/b9d211c6-4494-4498-bc05-c7d8588ef848