Objective: To evaluate the long-term effects of bilateral STN-DBS and levodopa on axial symptoms in PD patients and the possible correlations between speech and gait parameters.

Background: Bilateral STN-DBS represents a long-term effective treatment in advanced PD. Many studies have instrumentally assessed axial symptoms in PD patients focusing only on gait or speech disturbances. The very few studies that have instrumentally assessed the whole spectrum of axial symptoms in PD have showed the presence of similarities between spatial-temporal gait and speech parameters.

Method: This observational study included consecutive PD patients treated with bilateral STN-DBS. Axial symptoms have been assessed in the long-term after surgery applying a standardized clinical-instrumental approach with the contemporary analysis of speech (through a perceptual-acoustic assessment) and gait (trough the instrumented timed up and go test [iTUG]). Disease severity was assessed using the UPDRS part III. Different stimulation and drug conditions were studied: on-stimulation/off-medication, off-stimulation/off-medication, on-stimulation/on-medication conditions (single and dual task).

Results: 25 PD patients treated with bilateral STN-DBS with a five years follow-up were included. Comparing the three postoperative conditions, both stimulation alone and the combination of stimulation and medications led to an improvement of motor scores and most of gait parameters, with heterogenous effects on speech variables. In the on-stimulation/on-medication condition patients with a poorer voice quality performed worse the sit to stand and gait phases of the iTUG. On the contrary, patients with a higher speech rate performed well the turning and walking phases of the iTUG, assuming that these specific speech and gait parameters may be influenced in the same way by levodopa and stimulation.

Conclusion: Our data highlights that STN-DBS and levodopa could improve gait parameters in the long-term after surgery, with mixed effect on speech parameters. Different correlations between speech and gait parameters were also found. This may allow to better understand the common pathophysiological basis of these alterations and to develop a more specific and tailored rehabilitation approach after surgery.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/assessment-of-the-long-term-effects-of-stn-dbs-on-axial-symptoms-in-pd-patients-through-a-standardized-clinical-instrumental-approach/