Lower limb joints kinematics in essential tremor and the effect of thalamic stimulation

Gait & Posture
Alfonso FasanoGünther Deuschl

Abstract

Following the hypothesis that thalamic deep brain stimulation improves ataxia in patients with essential tremor by modulating the cerebello-thalamo-cortical pathway, we examined the joint kinematics of lower limbs during uninterrupted gait in eleven patients who have been treated with bilateral thalamic stimulation for 24.7±20.3 months. Patients were assessed under routine chronic stimulation, supra-therapeutic amplitude, and off stimulation by means of an infrared movement analysis system while walking on a treadmill. Chronic thalamic DBS normalized the highly variable excursion throughout the gait cycle that characterized the subgroup of patients with longest disease duration. Supratherapeutic thalamic DBS amplitude did not reproduce such improvements while, more importantly, it induced ataxic changes of joint excursion. The normalization of kinematic abnormalities argues against the hypothesis of a cerebellar neurodegeneration in ET. Moreover, these results suggest that the beneficial effect of thalamic DBS on ataxic symptoms is limited to a narrow therapeutic window.

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Citations

Apr 18, 2013·Current Neurology and Neuroscience Reports·Rodger J Elble
Nov 28, 2013·Brain : a Journal of Neurology·Sergiu GroppaJens Volkmann
Oct 5, 2013·Continuum : Lifelong Learning in Neurology·Alfonso Fasano, Bastiaan R Bloem
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Mar 24, 2016·IEEE Reviews in Biomedical Engineering·Maria do Carmo Vilas-Boas, Joao Paulo Silva Cunha
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Dec 4, 2019·Clinical Neurophysiology : Official Journal of the International Federation of Clinical Neurophysiology·B J WilkesD E Vaillancourt
Dec 16, 2020·Neurology India·Manmohan Singh, Mohit Agrawal

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