Gait and balance disorders in Parkinson's disease: Impaired active braking of the fall of centre of gravity |
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| Authors: | Nathalie Chastan MD PhD Manh Cuong Do PhD Fabrice Bonneville MD PhD Frédéric Torny MD Frédéric Bloch MD G W Max Westby PhD Didier Dormont MD PhD Yves Agid MD PhD Marie‐Laure Welter MD PhD |
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| Affiliation: | 1. Fédération des Maladies du Système Nerveux, Centre d'Investigation Clinique, Assistance Publique‐H?pitaux de Paris, H?pital Pitié‐Salpêtrière, Paris, France;2. Institut National de la Santé et de la Recherche Médicale, Unité 679, Paris, France;3. Université Pierre et Marie Curie‐Paris 6, Institut Fédératif de Recherche (IFR‐70), Paris, France;4. Service de Neurophysiologie, Centre Hospitalier Universitaire de Rouen, Rouen, France;5. Centre National de la Recherche Scientifique, FRE 2507, Institut des Systémes Intelligents et de Robotique, Paris, France;6. LCMP/UFR STAPS‐Orsay, Université Paris‐Sud 11, Orsay, France;7. Service de Neuroradiologie, Assistance Publique‐H?pitaux de Paris, H?pital Pitié‐Salpêtrière, Paris, France;8. Centre National de la Recherche et de la Santé, UPR640, Paris, France;9. Groupe AVENIR‐IFR 70, Institut National de la Santé et de la Recherche Médicale, Paris, France |
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| Abstract: | Gait and balance disorders are common in Parkinson's disease (PD), but its pathophysiology is still poorly understood. Step length, antero‐posterior, and vertical velocities of the center of gravity (CG) during gait initiation were analyzed in 32 controls and 32 PD patients, with and without levodopa, using a force platform. Brain volumes and mesencephalic surface area were measured in PD patients. During the swing limb period, controls showed a fall in the CG, which was reversed before foot‐contact indicating active braking of the CG fall. In PD patients, without levodopa, step length and velocity were significantly reduced and no braking occurred before foot‐contact in 22 patients. With levodopa, step length and velocity increased in all patients and 7 patients improved their braking capacity. PD patients with normal braking (n = 17) had significantly lower gait and balance disorder scores and higher normalized‐mesencephalic surface areas compared to patients with impaired braking (n = 15). The decreased step length and velocity, characteristic of PD, mainly result from degeneration of central dopaminergic systems. The markedly decreased braking capacity observed in half the PD patients contributes to their gait disorders and postural instability, perhaps as a result of nondopaminergic lesions, possibly at the mesencephalic level. © 2008 Movement Disorder Society |
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| Keywords: | Parkinson's disease gait initiation postural instability magnetic resonance imaging |
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