Balance control systems in Parkinson’s disease and the impact of pedunculopontine area stimulation

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dc.contributor.authorPerera, Thushara
dc.contributor.authorTan, Joy
dc.contributor.authorCole, Michael
dc.contributor.authorYohanandan, Shivanthan
dc.contributor.authorSilberstein, Paul
dc.contributor.authorCook, Raymond
dc.contributor.authorPeppard, Richard
dc.contributor.authorAziz, Tipu
dc.contributor.authorCoyne, Terry
dc.contributor.authorBrown, Peter
dc.contributor.authorSilburn, Peter
dc.contributor.authorThevathasan, Wesley
dc.date.accessioned2018-09-03T05:31:09Z
dc.date.available2018-09-03T05:31:09Z
dc.date.issued2018-08
dc.description.abstractImpaired balance is a major contributor to falls and diminished quality of life in Parkinson's disease, yet the pathophysiology is poorly understood. Here, we assessed if patients with Parkinson's disease and severe clinical balance impairment have deficits in the intermittent and continuous control systems proposed to maintain upright stance, and furthermore, whether such deficits are potentially reversible, with the experimental therapy of pedunculopontine nucleus deep brain stimulation. Two subject groups were assessed: (i) 13 patients with Parkinson's disease and severe clinical balance impairment, implanted with pedunculopontine nucleus deep brain stimulators; and (ii) 13 healthy control subjects. Patients were assessed in the OFF medication state and blinded to two conditions; off and on pedunculopontine nucleus stimulation. Postural sway data (deviations in centre of pressure) were collected during quiet stance using posturography. Intermittent control of sway was assessed by calculating the frequency of intermittent switching behaviour (discontinuities), derived using a wavelet-based transformation of the sway time series. Continuous control of sway was assessed with a proportional-integral-derivative (PID) controller model using ballistic reaction time as a measure of feedback delay. Clinical balance impairment was assessed using the 'pull test' to rate postural reflexes and by rating attempts to arise from sitting to standing. Patients with Parkinson's disease demonstrated reduced intermittent switching of postural sway compared with healthy controls. Patients also had abnormal feedback gains in postural sway according to the PID model. Pedunculopontine nucleus stimulation improved intermittent switching of postural sway, feedback gains in the PID model and clinical balance impairment. Clinical balance impairment correlated with intermittent switching of postural sway (rho = - 0.705, P < 0.001) and feedback gains in the PID model (rho = 0.619, P = 0.011). These results suggest that dysfunctional intermittent and continuous control systems may contribute to the pathophysiology of clinical balance impairment in Parkinson's disease. Clinical balance impairment and their related control system deficits are potentially reversible, as demonstrated by their improvement with pedunculopontine nucleus deep brain stimulation.en_US
dc.description.sponsorshipThis work was supported by funding through the National Health and Medical Research Council (1066565), the Victorian Lions Foundation, Colonial Foundation, Brain Foundation, and The Victorian Government’s Operational Infrastructure Support Programme.en_US
dc.identifier.citationPerera, T., J. L. Tan, M. H. Cole, S. A. C. Yohanandan, P. Silberstein, R. Cook, R. Peppard, T. Aziz, T. Coyne, P. Brown, P. A. Silburn, and W. Thevathasan. 2018. Balance control systems in Parkinson's disease and the impact of pedunculopontine area stimulation. Brain: [epub ahead of print].en_US
dc.identifier.issn0006-8950
dc.identifier.urihttp://repository.bionicsinstitute.org:8080/handle/123456789/316
dc.language.isoenen_US
dc.publisherBrainen_US
dc.subjectBrainstemen_US
dc.subjectMotor controlen_US
dc.subjectGaiten_US
dc.subjectNeurophysiologyen_US
dc.subjectDeep brain stimulationen_US
dc.titleBalance control systems in Parkinson’s disease and the impact of pedunculopontine area stimulationen_US
dc.typeArticleen_US
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