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Association of Depression With Early Occurrence of Postural Instability in Parkinson’s Disease
Yun Su Hwang, Sungyang Jo, Kye Won Park, Seung Hyun Lee, Sangjin Lee, Sun Ju Chung
J Mov Disord. 2023;16(1):68-78.   Published online December 20, 2022
DOI: https://doi.org/10.14802/jmd.22091
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  • 67 Download
AbstractAbstract PDFSupplementary Material
Objective
Depression in Parkinson’s disease (PD) affects the quality of life of patients. Postural instability and gait disturbance are associated with the severity and prognosis of PD. We investigated the association of depression with axial involvement in early-stage PD patients.
Methods
This study involved 95 PD patients unexposed to antiparkinsonian drugs. After a baseline assessment for depression, the subjects were divided into a depressed PD group and a nondepressed PD group. Analyses were conducted to identify an association of depression at baseline with the following outcome variables: the progression to Hoehn and Yahr scale (H-Y) stage 3, the occurrence of freezing of gait (FOG), levodopa-induced dyskinesia, and wearing-off. The follow-up period was 53.40 ± 16.79 months from baseline.
Results
Kaplan–Meier survival curves for H-Y stage 3 and FOG showed more prominent progression to H-Y stage 3 and occurrences of FOG in the depressed PD group than in the nondepressed PD group (log-rank p = 0.025 and 0.003, respectively). Depression in drug-naïve, early-stage PD patients showed a significant association with the progression to H-Y stage 3 (hazard ratio = 2.55; 95% confidence interval = 1.32–4.93; p = 0.005), as analyzed by Cox regression analyses. In contrast, the occurrence of levodopa-induced dyskinesia and wearing-off did not differ between the two groups (log-rank p = 0.903 and 0.351, respectively).
Conclusion
Depression in drug-naïve, early-stage PD patients is associated with an earlier occurrence of postural instability. This suggests shared nondopaminergic pathogenic mechanisms and potentially enables the prediction of early development of postural instability.
Long-term Effects of Bilateral Subthalamic Deep Brain Stimulation on Postural Instability and Gait Difficulty in Patients with Parkinson’s Disease
Hae-Won Shin, Mi Sun Kim, Sung Reul Kim, Sang Ryong Jeon, Sun Ju Chung
J Mov Disord. 2020;13(2):127-132.   Published online May 29, 2020
DOI: https://doi.org/10.14802/jmd.19081
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  • 195 Download
  • 3 Citations
AbstractAbstract PDF
Objective
The long-term effects of bilateral subthalamic nucleus deep brain stimulation (STN-DBS) on postural instability and gait difficulty (PIGD) in patients with Parkinson’s disease (PD) remain unclear. In this study, we aimed to evaluate the longterm effects of STN-DBS surgery on PIGD symptoms in patients with advanced-stage PD. Methods This study included 49 consecutively included patients with PD who underwent bilateral STN-DBS. The Unified Parkinson’s Disease Rating Scale (UPDRS) scores and subscores for PIGD were assessed at baseline and at 1, 3, and 5 years postoperatively. The PIGD subscore was divided into PIGD-motor and PIGD-activities of daily living (ADL) scores according to parts III and II of the UPDRS, respectively. Results The PIGD-motor and PIGD-ADL scores at the “medication-off” state improved at 3 and 5 years, respectively. Overall, the UPDRS III and II scores at “medication-off” improved at 5 years. The UPDRS IV score also significantly improved and the levodopa equivalent daily dosage decreased at all follow-ups. Finally, the PIGD-motor score at baseline was able to predict long-term improvement in the PIGD-motor score at the 5-year follow-up. Conclusion The STN-DBS has both short- and long-term effects on PIGD, as well as overall motor function, in patients with advanced PD. The degree of PIGD at the preoperative evaluation can be used to predict long-term outcomes after STN-DBS surgery.

Citations

Citations to this article as recorded by  
  • Long-term motor outcomes of deep brain stimulation of the globus pallidus interna in Parkinson's disease patients: Five-year follow-up
    Yun Su Hwang, Sungyang Jo, Seung Hyun Lee, Nayoung Kim, Mi-Sun Kim, Sang Ryong Jeon, Sun Ju Chung
    Journal of the Neurological Sciences.2023; 444: 120484.     CrossRef
  • The Role of Microelectrode Recording in Deep Brain Stimulation Surgery for Parkinson’s Disease: A Systematic Review and Meta-Analysis
    R. Saman Vinke, Martin Geerlings, Ashok K. Selvaraj, Dejan Georgiev, Bastiaan R. Bloem, Rianne A.J. Esselink, Ronald H.M.A. Bartels
    Journal of Parkinson's Disease.2022; 12(7): 2059.     CrossRef
  • Axial impairment and falls in Parkinson’s disease: 15 years of subthalamic deep brain stimulation
    Alessandro Zampogna, Francesco Cavallieri, Francesco Bove, Antonio Suppa, Anna Castrioto, Sara Meoni, Pierre Pélissier, Emmanuelle Schmitt, Amélie Bichon, Eugénie Lhommée, Andrea Kistner, Stephan Chabardès, Eric Seigneuret, Valerie Fraix, Elena Moro
    npj Parkinson's Disease.2022;[Epub]     CrossRef
Can Postural Instability Respond to Galvanic Vestibular Stimulation in Patients with Parkinson’s Disease?
Hiroshi Kataoka, Yohei Okada, Takao Kiriyama, Yorihiro Kita, Junji Nakamura, Shu Morioka, Koji Shomoto, Satoshi Ueno
J Mov Disord. 2016;9(1):40-43.   Published online December 3, 2015
DOI: https://doi.org/10.14802/jmd.15030
  • 20,227 View
  • 179 Download
  • 32 Citations
AbstractAbstract PDFSupplementary Material
Objective
Galvanic vestibular stimulation (GVS) activates the vestibular afferents, and these changes in vestibular input exert a strong influence on the subject’s posture or standing balance. In patients with Parkinson’s disease (PD), vestibular dysfunction might contribute to postural instability and gait disorders.
Methods
Current intensity was increased to 0.7 mA, and the current was applied to the patients for 20 minutes. To perform a sham stimulation, the current intensity was increased as described and then decreased to 0 mA over the course of 10 seconds. The patient’s status was recorded continuously for 20 minutes with the patient in the supine position.
Results
Three out of 5 patients diagnosed with PD with postural instability and/or abnormal axial posture showed a reduction in postural instability after GVS. The score for item 12 of the revised Unified Parkinson’s Disease Rating Scale part 3 was decreased in these patients.
Conclusions
The mechanism of postural instability is complex and not completely understood. In 2 out of the 5 patients, postural instability was not changed in response to GVS. Nonetheless, the GVS-induced change in postural instability for 3 patients in our study suggests that GVS might be a therapeutic option for postural instability.

Citations

Citations to this article as recorded by  
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    PLOS ONE.2023; 18(2): e0273883.     CrossRef
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    Karen McConnell, Daniel Topley, Jason McKeown, Claire Kerr
    BMC Pediatrics.2022;[Epub]     CrossRef
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    Hiroshi Kataoka, Yohei Okada, Takao Kiriyama, Yorihiro Kita, Junji Nakamura, Koji Shomoto, Kazuma Sugie
    Journal of Central Nervous System Disease.2022; 14: 117957352210815.     CrossRef
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    Anna Paula Batista de Ávila Pires, Tatiana Rocha Silva, Maíra Soares Torres, Maria Luiza Diniz, Maurício Campelo Tavares, Denise Utsch Gonçalves
    Brazilian Journal of Otorhinolaryngology.2022; 88: S202.     CrossRef
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    Yao Guo, Jianxin Yang, Yuxuan Liu, Xun Chen, Guang-Zhong Yang
    Frontiers in Aging Neuroscience.2022;[Epub]     CrossRef
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    Ram Mohan, Mohan Jayabal, Rashmi Ramanathan, Jeevithan Shanmugam, Archana R
    Asian Journal of Pharmaceutical and Clinical Research.2022; : 84.     CrossRef
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    Mohammad Mahmud, Zaeem Hadi, Mabel Prendergast, Matteo Ciocca, Abdel Rahman Saad, Yuscah Pondeca, Yen Tai, Gregory Scott, Barry M. Seemungal
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    Journal of Complementary and Integrative Medicine.2021; 18(4): 657.     CrossRef
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    Ghazaleh Samoudi, Andrea Nilsson, Thomas Carlsson, Filip Bergquist
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JMD : Journal of Movement Disorders