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. 2023 Aug 25;13(9):1243.
doi: 10.3390/brainsci13091243.

Postural Instability and Risk of Falls in Patients with Parkinson's Disease Treated with Deep Brain Stimulation: A Stabilometric Platform Study

Giorgio Leodori  1   2 , Marco Santilli  1 , Nicola Modugno  1 , Michele D'Avino  1 , Maria Ilenia De Bartolo  2 , Andrea Fabbrini  2 , Lorenzo Rocchi  3 , Antonella Conte  1   2 , Giovanni Fabbrini  1   2 , Daniele Belvisi  1   2
Affiliations

Postural Instability and Risk of Falls in Patients with Parkinson's Disease Treated with Deep Brain Stimulation: A Stabilometric Platform Study

Giorgio Leodori et al. Brain Sci. .

Abstract

Postural instability (PI) in Parkinson's disease (PD) exposes patients to an increased risk of falls (RF). While dopaminergic therapy and deep brain stimulation (DBS) improve motor performance in advanced PD patients, their effects on PI and RF remain elusive. PI and RF were assessed using a stabilometric platform in six advanced PD patients. Patients were evaluated in OFF and ON dopaminergic medication and under four DBS settings: with DBS off, DBS bilateral, and unilateral DBS of the more- or less-affected side. Our findings indicate that dopaminergic medication by itself exacerbated PI and RF, and DBS alone led to a decline in RF. No combination of medication and DBS yielded a superior improvement in postural control compared to the baseline combination of OFF medication and the DBS-off condition. Yet, for ON medication, DBS significantly improved both PI and RF. Among DBS conditions, DBS bilateral provided the most favorable outcomes, improving PI and RF in the ON medication state and presenting the smallest setbacks in the OFF state. Conversely, the more-affected side DBS was less beneficial. These preliminary results could inform therapeutic strategies for advanced PD patients experiencing postural disorders.

Keywords: Parkinson’s disease; deep brain stimulation; fall risk; falls; movement disorders; postural control; postural instability; stabilometric platform.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
UPDRS-III values across conditions. Data points and grey lines represent single subject mean values. Black line represents mean values across subjects. Conditions: OFF medication (MEDoff), ON medication (MEDon), off DBS (DBSoff), bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) (DBSbi), unilateral STN DBS of the more affected side (DBSmore), and of the less affected side (DBSless).
Figure 2
Figure 2
PI values across conditions. Data points and grey lines represent single subject values. Black line represents mean values across subjects. Conditions: OFF medication (MEDoff), ON medication (MEDon), off DBS (DBSoff), bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) (DBSbi), unilateral STN DBS of the more affected side (DBSmore), and of the less affected side (DBSless).
Figure 3
Figure 3
RF values across conditions. Data points and grey lines represent single subject values. Black line represents mean values across subjects. Conditions: OFF medication (MEDoff), ON medication (MEDon), off DBS (DBSoff), bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) (DBSbi), unilateral STN DBS of the more affected side (DBSmore), and of the less affected side (DBSless).
See this image and copyright information in PMC

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