Automated and objective measures of gait dynamics in camptocormia Parkinson's Disease subthalamic deep brain stimulation.

OBJECTIVE

Axial motor features are common in Parkinson's disease (PD). These include gait impairment and postural abnormalities, such as camptocormia. The response of these symptoms to deep brain stimulation (DBS) is variable and difficult to assess objectively. For the first time, this study analyzes the treatment outcomes of two PD patients with camptocormia that underwent bilateral subthalamic nucleus (STN)-DBS evaluated with disruptive technologies.

PATIENTS AND

METHODS

Two patients with PD and camptocormia who underwent STN-DBS were included. Gait parameters were quantitatively assessed before and after surgery by using the NeuroKinect system and the camptocormia angle was measured using the camptoapp.

RESULTS

After surgery, patient 1 improved 29 points in the UPDRS-III. His camptocormia angle was 68° before and 38° after surgery. Arm and knee angular amplitudes (117.32 ± 7.47 vs 134.77 ± 2.70°; 144.51 ± 7.47 vs 169.08 ± 3.27°) and arm swing (3.59 ± 2.66 vs 5.40 ± 1.76 cm) improved when compared with his preoperative measurements. Patient 2 improved 22 points in the UPDRS-III after surgery. Her camptocormia mostly resolved (47° before to 9° after surgery). Gait analysis revealed improvement of stride length (0.29 ± 0.03 vs 0.35 ± 0.03 m), stride width (18.25 ± 1.16 vs 17.9 ± 0.84 cm), step velocity (0.91 ± 0.57 vs 1.33 ± 0.48 m/s), arm swing (4.51 ± 1.01 vs 7.38 ± 2.71 cm) and arm and hip angular amplitudes (131.57 ± 2.45° vs 137.75 ± 3.18; 100.51 ± 1.56 vs 102.18 ± 1.77°) compared with her preoperative results.

CONCLUSION

The gait parameters and camptocormia of both patients objectively improved after surgery, as assessed by the two quantitative measurement systems. STN-DBS might have a beneficial effect on controlling axial posturing and gait, being a potential surgical treatment for camptocormia in patients with PD. However, further studies are needed to derive adequate selection criteria for this patient population.