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. 2025 Jan;32(1):e16580.
doi: 10.1111/ene.16580.

Evaluating gait and postural responses to subthalamic stimulation and levodopa: A prospective study using wearable technology

Ilaria Cani  1   2 , Ilaria D'Ascanio  3 , Luca Baldelli  1   2 , Giovanna Lopane  4 , Saverio Ranciati  5 , Paolo Mantovani  6 , Alfredo Conti  2   6 , Pietro Cortelli  1   2 , Giovanna Calandra-Buonaura  1   2 , Lorenzo Chiari  3   7 , Luca Palmerini  3 , Giulia Giannini  1   2
Affiliations

Evaluating gait and postural responses to subthalamic stimulation and levodopa: A prospective study using wearable technology

Ilaria Cani et al. Eur J Neurol. 2025 Jan.

Abstract

Background: The efficacy of subthalamic stimulation on axial signs of Parkinson's disease (PD) is debated in the literature. This study delves into the dynamic interplay of gait and posture, specifically probing their nuanced response to subthalamic stimulation and levodopa.

Methods: We used wearable sensor technology to examine alterations in the spatiotemporal parameters of gait and posture in individuals with PD before and 6 months after subthalamic deep brain stimulation (STN-DBS) surgery. Thirty-three subjects with PD were evaluated in two pre-operative and four post-operative conditions comprising OFF/ON medication and stimulation states. Standardized response mean (SRM) values were calculated to assess treatment responsiveness.

Results: Significant improvements in spatiotemporal gait parameters, including speed, stride length, cadence, and turning, were observed following STN-DBS surgery. Quantitatively, stimulation outperformed levodopa in enhancing gait speed, stride length, and turning, as indicated by SRM. Levodopa moderately improved stride time variability and asymmetry, while stimulation alone demonstrated limited efficacy. Postural parameters exhibited minimal change following STN-DBS, although stimulation showed a slight benefit in certain postural aspects.

Conclusion: Our findings suggest positive effects of stimulation and levodopa on gait and postural parameters, with STN-DBS demonstrating superior efficacy in enhancing gait speed, stride length, and turning. However, gait variability remains unaddressed by current therapies, highlighting the need for novel treatments targeting regions beyond the basal ganglia.

Keywords: Parkinson's disease; deep brain stimulation; inertial measurement units; kinematic analysis; neuromodulation.

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Conflict of interest statement

Luca Palmerini and Lorenzo Chiari are co‐founders and own shares of mHealth Technologies. Ilaria Cani, Ilaria D'Ascanio, Luca Baldelli, Giovanna Lopane, Saverio Ranciati, Paolo Mantovani, Alfredo Conti, Pietro Cortelli, Giovanna Calandra‐Buonaura, and Giulia Giannini declare no financial or non‐financial competing interests.

Figures

FIGURE 1
FIGURE 1
Motor tasks included in the DBS monitoring protocol. Tasks analyzed in this study Timed Up and Go test—TUG, 18‐m walking test—GAIT, Quiet standing test—SWAY) are outlined in bold.
FIGURE 2
FIGURE 2
Radar plot of sensor‐based locomotor parameters in pre‐DBS (med‐OFF, dashed line) and post‐DBS (med‐OFF/stim‐ON, solid line) evaluations, both in single (2a) and dual (2b) task mode. Outer values represent better motor performance, with a larger area indicating improved gait functionality. *: Statistically significant differences between pre‐DBS and post‐DBS conditions according to paired data Wilcoxon test (p‐value <0.05).
FIGURE 3
FIGURE 3
Radar plot of sensor‐based locomotor parameters post‐DBS, both in single (3a) and dual (3b) task mode. Medication and stimulation conditions are distinguished by color. Outer values represent better motor performance, with a larger area indicating improved gait functionality. *: Statistically significant differences between the four conditions according to Friedman test (p‐value <0.05).
FIGURE 4
FIGURE 4
Responsiveness of the sensor‐based parameters to subthalamic stimulation (med‐OFF/stim‐ON vs. med‐OFF/stim‐OFF), to levodopa medication (med‐ON/stim‐OFF vs. med‐OFF/stim‐OFF), and their combined effect (med‐ON/stim‐ON vs. med‐OFF/stim‐OFF), both in single and dual‐task mode. SRM values 0.20–0.50, 0.51–0.80, and >0.80 indicate small, moderate, and large responsiveness, respectively. Negative values indicate worsening under the respective treatment compared to the baseline condition med‐OFF/stim‐OFF.
See this image and copyright information in PMC

References

    1. Limousin P, Foltynie T. Long‐term outcomes of deep brain stimulation in Parkinson disease. Nat Rev Neurol. 2019;15:234‐242. doi:10.1038/s41582-019-0145-9 - DOI - PubMed
    1. Goetz CG, Tilley BC, Shaftman SR, et al. Movement Disorder Society‐sponsored revision of the unified Parkinson's disease rating scale (MDS‐UPDRS): scale presentation and clinimetric testing results. Mov Disord. 2008;23:2129‐2170. doi:10.1002/mds.22340 - DOI - PubMed
    1. Deuschl G, Schade‐Brittinger C, Krack P, et al. A randomized trial of deep‐brain stimulation for Parkinson's disease. N Engl J Med. 2006;355:896‐908. doi:10.1056/nejmoa060281 - DOI - PubMed
    1. Vitek JL, Jain R, Chen L, et al. Subthalamic nucleus deep brain stimulation with a multiple independent constant current‐controlled device in Parkinson's disease (INTREPID): a multicentre, double‐blind, randomised, sham‐controlled study. The Lancet Neurology. 2020;19:491‐501. doi:10.1016/S1474-4422(20)30108-3 - DOI - PubMed
    1. Mera TO, Filipkowski DE, Riley DE, et al. Quantitative analysis of gait and balance response to deep brain stimulation in Parkinson's disease. Gait Posture. 2013;38:109‐114. doi:10.1016/j.gaitpost.2012.10.025 - DOI - PMC - PubMed

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