Subthalamic deep brain stimulation and trunk posture in Parkinson's disease

Objectives We sought to assess the efficacy of subthalamic nucleus deep brain stimulation ( STN ‐ DBS ) in Parkinson's disease ( PD )‐associated trunk posture abnormalities retrospectively analyzing data from 101 patients reporting mild‐to‐severe trunk posture abnormalities of a cohort of 216 PD patients treated with STN ‐ DBS at our center. Methods Abnormal trunk posture was rated on a scale of 0 (normal) to 4 (marked flexion with an extreme abnormality of posture) as per the grading score reported in the Unified Parkinson's Disease Rating Scale. The independent effect of STN ‐ DBS on trunk posture was assessed comparing Medication‐Off (presurgery) vs Stimulation‐On/Medication‐Off (post‐surgery). The combined effect of STN ‐ DBS plus levodopa was evaluated comparing Medication‐On (presurgery) vs Stimulation‐On/Medication‐On (post‐surgery). Analyses were conducted considering both the entire cohort of patients and the subgroup with camptocormia ( CMC ) and Pisa syndrome ( PS ). Results The independent effect of STN ‐ DBS resulted in a 41.4% improvement in abnormal trunk posture severity ( P  < .001), with 78.2% of patients (n = 79) reporting an improvement of at least 1 point. The combined effect of STN ‐ DBS and levodopa resulted in a 30.9% improvement ( P  = .061), with 54.5% of patients (n = 55) reporting an improvement of at least 1 point. The subanalysis of patients with CMC (n = 23) and PS (n = 5) showed a 42.7% improvement in abnormal posture severity when considering the independent effect of STN ‐ DBS ( P  < .001) and 30.5% when considering the combined effect of STN ‐ DBS and levodopa ( P  < .001). Conclusions STN ‐ DBS may have the potential for improving posture in patients with advanced PD .