Background: Gait disturbances and balance remain challenging issues in Parkinsonian patients (PD) with deep brain stimulation (DBS). Short pulse deep brain stimulation (spDBS) increases the therapeutic window in PD patients, yet the effect on gait and postural symptoms remains unknown. Objective: We assessed the efficacy of spDBS compared to conventional DBS (cDBS) within the subthalamic nucleus (STN) on Parkinsonian gait. Methods: The study was a single-centre, randomized, double-blind, clinical short-term trial. 20 PD patients were studied postoperatively in three different conditions (DBS stimulation switched off (off DBS), spDBS with 40μs pulse width, cDBS with 60μs pulse width) on regular medication. The primary endpoint was the relative difference of gait velocity at self-paced speed during quantitative gait analysis between stimulation conditions. Secondary endpoints were changes of further measures of quantitative gait analysis, Ziegler course, Berg balance scale, FOG questionnaire, MDS-UPDRS, PDQ-39, and HADS. Mixed-model analysis and post-hoc t-tests were performed. Results: Both spDBS and cDBS improved gait velocity at self-paced speed compared to off DBS, however, there was no significant difference between both stimulation modes. Still, nearly half of the patients preferred spDBS over cDBS subjectively. Both stimulation modes were equally effective in improving secondary endpoints of gait, balance, motor and non-motor performances. Conclusion: The use of spDBS and cDBS is equally effective in improving gait and balance in PD and might be beneficial in specified cohorts of PD patients.
The purpose of this study was to utilize the technique of quantitative gait analysis on individuals with multiple sclerosis (MS) to provide a more accurate representation of gait patterns than subjective clinician observation alone and then compare those patterns to reported results from normal subjects without neurological disorders. Ten subjects with MS were evaluated by clinical quantitative gait analysis. The results indicated that individuals with M S responded with a 9% decrease in cadence, 7.5 YO decrease in velocity, 8% decrease in stride length, 17% increase in single stance time, and 56% increase in double stance time compared to normal values. There were also diminished angular displacement values for the hip, knee, and ankle, with an increase measured in pelvic tilt. Ground reaction forces were found to be significantly different for vertical forces and anterior-posterior forces. These data appear to suggest that the technique of quantitative gait analysis can provide accurate scientific assessment of gait disturbances through evaluation of kinetic, kinematic, and temporal variables and subjects diagnosed with M S may have impaired gait patterns that may not be evident during subjective analysis alone.
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