Unilateral and Bilateral Subthalamic Nucleus Stimulation in Parkinson's Disease: Effects on EMG Signals of Lower Limb Muscles During Walking

The effects of subthalamic nucleus (STN) stimulation on the spatio-temporal organization of locomotor commands directed to lower limb muscles were studied in subjects with idiopathic Parkinson's Disease (PD) by recording the EMG activity produced during steady-state walking in representative thigh (rectus femoris, RF, and semimembranosus, SM) and leg (gastrocnemius medialis, GAM, and tibialis anterior, TA) muscles, under four experimental conditions: basal stimulation off, unilateral (right and left) stimulation on, and bilateral stimulation on. Locomotor profiles of all of the muscles tested were found to be substantially affected by STN stimulation, either in terms of restoration/enhancement of the main activity bursts or normalization of recruitment timing thereof. Responses showed relatively higher statistical significance in the distal groups (GAM and TA) and, within them, for the EMG components called into action over the ground-contact (ankle dorsiflexors) and midstance (ankle plantarflexors) phases of the stride cycle. In line with data obtained from clinical rating, unilateral stimulation produced less consistent EMG changes compared with bilateral stimulation. However, at variance with clinical effects, which prevailed on the side of the body contralateral to stimulation, EMG responses to unilateral stimulation were usually symmetrical. Results indicate that the impact of STN stimulation on locomotor activation of lower limb muscles in PD is characterized by: 1) substantial effects exhibiting differential topographical (distal versus proximal) and stride-phase (stance versus swing) consistency and 2) absence of the lateralized actions typically observed for the clinical signs of the disease. Interaction with the activity of functionally different executive systems might account for the observed pattern of responsiveness.