Dynamics of postural instability in Parkinson's disease patients undergoing bilateral subthalamic nucleus deep brain stimulation

Introduction. Subthalamic nucleus deep brain stimulation (STN DBS) is a highly effective method of neurosurgical treatment of Parkinson’s disease (PD), which can significantly reduce the motor symptoms of the disease (rigidity, tremor, hypokinesia). However, the effect of STN DBS postural stability remains contradictory.
The purpose of the study. Evaluation of the dynamics of postural instability in advanced PD patients undergoing bilateral STN DBS during 12 months of postoperative observation.
Materials and methods. The study included 80 patients with PD: 40 patients in the main group who undergoing STN DBS, and 40 patients in the control group who received only drug therapy. Patients in the main group underwent clinical neurological examination a week before surgery, as well as 3, 6 and 12 months after surgery; patients in the control group – at the beginning of the study and after 12 months of observation.
Results. SN DBS in patients of the main group led to a significant improvement in motor performance on the UPDRS-III scale, a decrease in the severity of postural instability during the «OFF» period, and improved confidence in balance on the ABC scale throughout the 12 months of observation (p<0,05). During the «ON» period, the STN DBS did not have a significant effect on the postural instability. After 12 months of follow- up, patients in the control group showed a significant increase in instability, hypokinesia, freezing, walking disorders, and motor deficits on the UPDRS-III scale. After 12 months, SN DBS contributed to a 73,43 % reduction in the daily dose of levodopa in patients in the main group and a decrease in the severity of motor fluctuations and dyskinesias on the UPDRS-IV scale by more than 70 %, while in the comparison group the dose of levodopa increased and the UPDRS-IV scores worsened. In patients with STN DBS, there was a regression of fluctuations in postural instability during periods of «ON» and «OFF» while taking levodopa.
Conclusions. After 12 months, patients undergoing bilateral STN DBS showed a significant decrease in the severity of postural instability during the «OFF» period and no effect on postural functions during the «ON» period. The stabilization of postural functions was revealed at a sufficient level, without fluctuation depending on the «ON» and «OFF» periods.

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