Different effects of unilateral versus bilateral subthalamic nucleus stimulation on walking and reaching in Parkinson's disease

Amy J. Bastian, Valerie E. Kelly, Fredy J. Revilla, Joel S. Perlmutter, Jonathan W. Mink

Research output: Contribution to journalArticlepeer-review

Abstract

The purpose of this study was to determine the effects of unilateral versus bilateral subthalamic nucleus (STN) stimulation on quantitative measures of walking and reaching in Parkinson's disease (PD). We used kinematic measures and the Unified Parkinson's Disease Rating Scale (UPDRS) motor subscale (subscale III) to evaluate the movement of 6 people with PD who had bilateral STN stimulators implanted for at least 6 months and withheld their anti-parkinson medication for at least 8 hours. Subjects were studied with both stimulators off, one on, and both on. Kinematic data were collected as subjects walked, reached to a target, and were rated using the UPDRS motor subscale. STN stimulation improved walking speed and stride length, with the greatest benefit from bilateral stimulation. Reaching speed was improved by unilateral STN stimulation alone, with no additive effect of bilateral stimulation. UPDRS motor subscale ratings paralleled the kinematic findings. STN stimulation did not restore PD subjects' movements to the level of age-matched controls. Overall, these results provide further evidence that the basal ganglia pathways involved in control of walking and reaching may be distinct. We speculate that basal ganglia may influence walking through bilateral pedunculopontine projections and reaching through ipsilateral thalamocortical projections. Our findings also suggest that maximal improvement of walking requires bilateral rather than unilateral STN stimulation.

Original languageEnglish (US)
Pages (from-to)1000-1007
Number of pages8
JournalMovement Disorders
Volume18
Issue number9
DOIs
StatePublished - Sep 1 2003

Keywords

  • Deep brain stimulation
  • Gait
  • Parkinson's disease

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

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