Turkish Neurosurgery 2019 , Vol 29 , Num 3
Comparison of Subthalamic Nucleus vs. Globus Pallidus Interna Deep Brain Stimulation in Terms of Gait and Balance; A Two Year Follow-Up Study
Ozkan CELIKER1,Goksemin DEMIR2,Murat KOCAOGLU1,Filiz ALTUG3, Feridun ACAR1
1Pamukkale University, Department of Neurosurgery, Denizli, Turkey
2Pamukkale University, Department of Neurosurgery Neurology, Denizli, Turkey
3Pamukkale University, School of Physical Therapy and Rehabilitation, Denizli, Turkey
DOI : 10.5137/1019-5149.JTN.22614-18.3 AIM: To compare the effects of subthalamic nucleus (STN) and globus pallidus interna (GPi) deep brain stimulation (DBS) on the motor outcome, gait and balance function, fall risk (FR), and non-motor symptoms in patients with advanced Parkinson’s disease (PD).

MATERIAL and METHODS: We randomized patients with advanced PD with the indication of DBS to undergo either STN or GPi DBS and followed them for 2 years. We collected data at baseline and postoperative 6, 12, and 24 months. We compared changes in the Unified Parkinson’s Disease Rating Scale (UPDRS) score, timed gait tests, posturography, non-motor symptom questionnaire (NMSQuest), hospital anxiety and depression (HAD) scale, and levodopa equivalent dose (LED).

RESULTS: We enrolled and randomized 12 patients to receive either STN (n = 6) or GPi (n = 6) DBS. Postoperative motor outcomes were significantly improved in both groups (p<0.05). In both groups, timed gait tests exhibited better performance in mobility; however, patients receiving GPi DBS performed better than those receiving STN DBS in the timed gait tests (p<0.05). Furthermore, the posturographic evaluation demonstrated a significant elevation in the FR in the STN group (p<0.05).

CONCLUSION: Both STN and GPi DBS are equally effective in alleviating disabling motor complications. However, seemingly, STN DBS could cause more gait and balance problems; hence, a tailored approach seems to be more appropriate in the target selection. Keywords : Advanced Parkinson’s disease, Subthalamic nucleus, Globus pallidus interna, Deep brain stimulation

Corresponding author : Goksemin DEMIR, gdemir@pau.edu.tr