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Pierre Krystkowiak, MD; Jean-Louis Blatt, MD, PhD; Jean-Louis Bourriez, PhD; Alain Duhamel, PhD; Miriam Perina, MD; Serge Blond, MD; Jean-Daniel Guieu, PhD; Alain Destée, MD; Luc Defebvre, MD, PhD

Arch Neurol. 2003;60:80-84.

Background  Stimulation of the subthalamic nucleus is proposed for the treatment of patients presenting with severe Parkinson disease. The effect on gait is not clearly established.

Objectives  To evaluate objectively the influence of bilateral subthalamic nucleus stimulation on gait in Parkinson disease and to compare it with the effects of levodopa treatment.

Methods  Ten patients underwent bilateral subthalamic nucleus stimulation. The preoperative and postoperative (3 months after surgery) clinical gait disturbances, as well as spatial and temporal gait parameters, were analyzed in off and on-drug conditions. The gait analysis was performed using a video motion analysis system (optoelectronic VICON system; Oxford Metrics, Oxford, England).

Results  In the off condition, there was an improvement after surgery for the total motor score and the gait subscore. In the on-drug condition, there was an improvement in levodopa-induced dyskinesias and the motor score, whereas the gait subscore was unchanged. For the gait parameters measured by the video motion analysis system system, there was also an improvement in the off condition and to a lesser extent in the on-drug condition.

Conclusions  Our method allowed exact quantification of the benefit of surgery on gait parameters. Compared with the levodopa treatment, the effect of stimulation on gait kinematic parameters seems to be qualitatively similar but quantitatively different with a lower benefit on gait velocity and stride length. Concerning the pathophysiology of gait troubles in Parkinson disease, the deficit in control of stride length would be the fundamental deficit. The study underlines the possible role of the subthalamic nucleus on the stride length regulation.

From the Departments of Gait Analysis (Drs Krystkowiak, Blatt, Bourriez, Blond, Guieu, Destée, and Defebvre), Neurology (Drs Krystkowiak, Perina, Destée, and Defebvre), Clinical Neurophysiology (Drs Blatt, Bourriez, and Guieu), Biostatics (Dr Duhamel), and Neurosurgery (Dr Blond), Centre Hospitalier et Universitaire de Lille, Lille, France.

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