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Title of Journal: J Neurol

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Abbravation: Journal of Neurology

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Springer Berlin Heidelberg

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DOI

10.1007/bf00434792

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1432-1459

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Dopaminergic medication does not improve stepping

Authors: Digna de Kam Jorik Nonnekes Lars B Oude Nijhuis Alexander C H Geurts Bastiaan R Bloem Vivian Weerdesteyn
Publish Date: 2014/09/17
Volume: 261, Issue: 12, Pages: 2330-2337
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Abstract

In this study we investigated the effect of dopaminergic medication on reactive stepping responses to forward and backward balance perturbations in patients with moderately severe Parkinson’s disease PD Twelve PD patients Hoehn and Yahr stage ranging from 2 to 3 and 15 healthy controls were exposed to multidirectional translational stance perturbations on a moveable platform Perturbations were unpredictable in terms of amplitude timing and direction Patients were tested in the medication ON and OFF at least 12 h of dopaminergic medication withdrawal state on two separate days Forward and backward stepping responses were quantified in terms of 1 presence onset and amplitude of anticipatory postural adjustments APAs 2 spatiotemporal step variables step onset length and velocity and 3 leg inclination angle at first steppingfoot contact When perturbed forward patients performed worse than controls in terms of step length 032 ± 007 vs 038 ± 005 m p = 001 and step velocity 121 ± 016 vs 137 ± 013 m/s p = 001 while step onset was not different The number of steps with an APA was larger in patients in the OFF state than in controls which was however only significant after forward perturbations 43 vs 20  p = 001 Following backward perturbations leg angles at foot contact were smaller in patients compared to controls −271° ± 429° vs 026° ± 280° p = 004 reflecting a poorer mechanical efficiency of the step Dopaminergic medication had no significant effect on any of these outcomes In conclusion dopaminergic medication does not improve underscaling of stepping responses in PD Therefore other interventions are needed to improve these important defense postural reactions

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