Abstract
The effect of subthalamic nucleus deep brain stimulation (STN-DBS) on balance function in patients with Parkinson’s disease (PD) and the potential outcome predictive factors remains unclear. We retrospectively included 261 PD patients who underwent STN-DBS and finished the 1-month follow-up (M1) assessment in the explorative set for identifying postoperative balance change predictors, and 111 patients who finished both the M1 and 12-month follow-up (M12) assessment in the validation set for verifying the identified factors. Motor and balance improvement were evaluated through the UPDRS-III and the Berg balance scale (BBS) and pull test (PT), respectively. Candidate predictors of balance improvement included age, disease duration, motor subtypes, baseline severity of PD, cognitive status, motor and balance response to levodopa, and stimulation parameters. In the off-medication condition, STN-DBS significantly improved BBS and PT performance in both the M1 and M12, in both datasets. While in the on-medication condition, no significant balance improvement was observed. Higher preoperative BBS response to levodopa was significantly associated with larger postoperative off-medication, but not on-medication, BBS (p < 0.001) and PT (p < 0.001) improvement in both the M1 and M12. BBS subitems 8, 9, 11, 13, and 14 were the major contributors to the prediction of balance improvement after STN-DBS. STN-DBS improves short-term off-medication, but not on-medication, balance function assessed through BBS and PT. Preoperative BBS response to levodopa best predicts postoperative off-medication balance improvement. For patients who manifested severe balance problems, a levodopa challenge test on BBS or the short version of BBS is recommended.
Highlights
Axial symptoms severely impact the quality of life in Parkinson’s disease (PD)
Others found that the probability of fall is increasing despite the improvement in postural instability gait difficulty (PIGD) subscore of unified Parkinson’s disease rating scale (UPDRS) after subthalamic nucleus (STN)-DBS3
There was no significant difference between the 2 sets, except that the patients in the validation set had better on-medication balance performance in Berg balance scale (BBS) at baseline (p = 0.016)
Summary
Falls due to balance problems and postural instability are associated with a higher risk of nursing home or admission to hospitals[1]. The subthalamic nucleus deep brain stimulation (STN-DBS) well controls the cardinal symptoms including tremor, rigidity, and bradykinesia in PD, its effect on balance function is still debating. Some researchers indicated that STN-DBS improves postural instability in the short-term, but not in the longterm follow-up[2]. Others found that the probability of fall is increasing despite the improvement in postural instability gait difficulty (PIGD) subscore of unified Parkinson’s disease rating scale (UPDRS) after STN-DBS3. One study suggested that STN-DBS may even directly worsen balance capability[4]. A recent article published in 2018 showed that STN-DBS did not worsen nor improve balance and postural instability[5]
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