Skip to main content
SpringerLink
Log in

Gait abnormalities induced by acquired bilateral pallidal lesions

A motion analysis study

  • ORIGINAL COMMUNICATION
  • Published:
Journal of Neurology Aims and scope Submit manuscript

Abstract

Background

Bilateral pallidal lesions induce a range of cognitive and motor disorders, principally a parkinsonian syndrome in which severe disturbances of gait and gait initiation are frequently reported. However, the precise clinical features of these disorders (and the role of the pallidum therein) remain to be established.

Objectives

The goal of this study was to characterise gait and gait initiation disorders within the context of a parkinsonian syndrome in patients with acquired, bilateral, pallidal lesions (PAL patients), to compare these disorders to those seen in Parkinson’s disease (PD), and to assess the corresponding physiopathological implications.

Patients and methods

By using a video motion analysis system (VICON), we studied gait kinematic parameters in two patients presenting with bilateral, pallidal lesions. Kinematic and kinetic parameters were also determined during gait initiation. The two patients were compared with a group of 17 PD patients and to 20 healthy controls.

Results

In both PAL and PD patients, kinematic parameters (gait and gait initiation) and kinetic parameters (gait initiation) were similarly impaired, evidenced by akinesia (difficulty in initiating gait characterized by impairment of anticipatory postural adjustments). Hypokinesia and bradykinesia (respectively reduced stride length and reduced speed during gait) were also noted.

Conclusion

The gait and gait initiation disorders seen in cases of bilateral pallidal lesions (namely akinesia, hypokinesia and bradykinesia) are similar to those observed in PD. Subject to confirmation in more extensive studies, we hypothesize that bipallidal patients may present higher level gait disorders,with potential mediation by cognitive impairment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Jellinger K (1986) Exogenous lesion of the pallidum in Handbook of Clinical Neurology. In:Vinken GWBPJ, Klawans, HL (eds) Elsevier science publishers: Amsterdam, pp 465–491

  2. Klawans HL, Stein RW, Tanner CM, Goetz CG (1982) A pure Parkinsonian syndrome following acute carbon monoxide intoxicatin. Arch Neurol 39:302–304

    PubMed  CAS  Google Scholar 

  3. Carella F, Grassi MP, Savoiardo M, Contri P, Rapuzzi B, Mangoni A (1988) Dystonic–parkinsonian syndrome after cyanide poisoning: clinical and MRI findings. J Neurol Neurosurg Psychiatry 51:1345–1348

    PubMed  CAS  Google Scholar 

  4. Fève AP, Fénelon G, Wallays C, Rémy P, Guillard A (1993) Axial motor disturbances after hypoxic lesions of the globus pallidus. Mov Disord 8:321–326

    Article  PubMed  Google Scholar 

  5. Benassi G, Rinaldi R, Azzimondi G, Stracciari A, D’Allessandro R, Pazzaglia P (1996) Acute generalized dystonia due to bilateral lesion of basal ganglia mainly affecting the nuclei pallidi. Ital J Neurol Sci 17:71–73

    Article  PubMed  CAS  Google Scholar 

  6. Schoser BGH, Groden C (1999) Subacute onset of oculogyric crises and generalized dystonia following intranasal administration of heroin. Addiction 94:431–434

    Article  PubMed  CAS  Google Scholar 

  7. Hawker K, Lang AE (1990) Hypotoxicischemic damage of the basal ganglia. Mov Disord 5:219–224

    Article  PubMed  CAS  Google Scholar 

  8. Haaxma R, Van Boxtel A, Brouwer WH, et al. (1995) Motor function in patient with bilateral lesions of the globus pallidus. Mov Disord 10:761–777

    Article  PubMed  CAS  Google Scholar 

  9. Laplane D, Baulac M, Pillon B, Panayotopoulou– Achimastos (1982) Perte de l’auto–activation psychique, activité compulsive d’allure obsessionnelle. Lésion lenticulaire bilatérale. Rev Neurol (Paris) 138:173–141

    Google Scholar 

  10. Laplane D, Dubois B (1998) Les troubles affectifs de la perte d’auto–activation psychique. comparaison avec ceux de l’athymhormie. Rev Neurol (Paris) 154:35–39

    PubMed  CAS  Google Scholar 

  11. Ali–Cherif A, Royere ML, Gosset A, Poncet M, Salamon G, Khalil R (1984) Behavior and mental activity disorders after carbon monoxide poisoning. Bilateral pallidal lesions. Rev Neurol (Paris) 140:401–405

    PubMed  CAS  Google Scholar 

  12. Stuss DT, Van Reekum R, Murphy KJ (2000) Differentiation of states and causes of apathy. In: Borod J (ed) The neuropsychology of emotion. New York, Oxford University Press, pp 340–363

  13. Knutsson E (1972) An analysis of parkinsonian gait. Brain 95:475–486

    PubMed  CAS  Google Scholar 

  14. Stern GM, Franklyn SE, Imms FJ, Prestidge SP (1983) Quantitative assessments of gait and mobility in Parkinson’s disease. J Neural Trans 19:202–214

    Google Scholar 

  15. Blin O, Fernandez AM, Serratrice G (1990) Quantitative analysis of gait in Parkinson’s patients: increased variability of stride lenght. Neurol Sci 98:91–97

    Article  CAS  Google Scholar 

  16. Burleigh–Jacobs A, Horak FB, Nutt GJ, Obeso JA (1997) Step Initiation in Parkinson’s Disease: Influence of Levodopa and External Sensory Triggers. Mov Disord 12:206–215

    Article  PubMed  CAS  Google Scholar 

  17. Krystkowiak P, Blatt JL, Bourriez JL, Duhamel A, Perina M, Kemoun G, Blond S, Guieu JD, Destée A, Defebvre L (2001) Chronic bilateral pallidal stimulation and levodopa do not improve gait in the same way in Parkinson’s disease: a study using a video motion analysis system. J Neurol 248:944–949

    Article  PubMed  CAS  Google Scholar 

  18. Krystkowiak P, Blatt JL, Bourriez JL, Duhamel A, Perina M, Blond S, Guieu JD, Destée A, Defebvre L (2003) Effects of subthalamic nucleus stimulation and levodopa treatment on gait troubles in Parkinson’s disease. Arch Neurol 60:80–84

    Article  PubMed  Google Scholar 

  19. Fahn S, Elton RL, and members of the UPDRS Development Committee (1987) Unified Idiopathic Parkinson’s Disease Rating Scale. In: Fahn S, Marsden CD, Calne D, Goldstein M (eds) Recent Developments in Parkinson’s Disease. Florham Park, NJ: MacMillan Healthcare Information 2: pp 153–164

  20. Folstein MF, Folstein SE, McHugh PR (1975) Mini–Mental State: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198

    Article  PubMed  CAS  Google Scholar 

  21. Mattis S Mental status examination for organic mental syndrome in the ederly patient (1976) In: Bellack L, Karasu TB (eds) Geriatric Psychiatry. New York: Grune and Stratton, pp 77–121

    Google Scholar 

  22. Dubois B, Slachevsky A, Litvan I, Pillon B (2000) The FAB: A frontal Assessment Battery at bedside. Neurology 55:1621–1626

    PubMed  CAS  Google Scholar 

  23. Montgomery SA, Åsberg M (1979) A new depression scale designed to be sensitive to change. Br J Psychiatry 134:322–389

    Google Scholar 

  24. Gibb WRG, Lees AJ (1988) The prevalence of the lewy body to the pathogenesis of idiopathic Parkinson’s disease. J Neurol Neurosurg Psychiatry 51:745–752

    Article  PubMed  CAS  Google Scholar 

  25. Elble R, Moody C, Leffler K, Sinha R (1994) The initiation of normal walking. Mov Disord 9:139–146

    Article  PubMed  CAS  Google Scholar 

  26. Shik ML (1986) An hypothesis on the bulbospinal locomotor column. Wenner–Gren International Symposium Series 45:39–49

    Google Scholar 

  27. Garcia–Rill E (1986) The basal ganglia and the locomotor region. Brain Res Rev 11:47–63

    Article  Google Scholar 

  28. Pahapill PA, Lozano AM (2000) The pedunculopontine nucleus and Parkinson’s disease. Brain 123:1767–1783

    Article  PubMed  Google Scholar 

  29. Nutt JG, Marsden CD, Thompson PD (1993) Human walking and higherlevel gait disorders, particularly in the elderly. Neurology 43:268–279

    PubMed  CAS  Google Scholar 

  30. Nakamura T, Meguro K, Yamazaki H, Okuzumi H, Tanaka A, Horikawa A, Yamaguchi K, Katsuyama N, Nakano M, Arai H, Sasaki H (1997) Postural and gait disturbance correlated with decreased frontal cerebral blood flow in Alzheimer disease. Alzheimer Dis Assoc Disord 11:132–139

    PubMed  CAS  Google Scholar 

  31. Alexander GE, Crutcher MD (1990) Functional architecture of basal ganglia circuits: neural substrates of parallel processing. TINS 13:266–271

    PubMed  CAS  Google Scholar 

  32. Joël D (2001) Open interconnected model of basal ganglia–thalamocortical circuitry and its relevance to the clinical syndrome of Huntington’s disease. Mov Disord 16:407–423

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Neurologie A, Hôpital R. Salengro, CHRU de Lille, 59037, Lille Cedex, France

    P. Krystkowiak MD, PhD, K. Dujardin PhD, A. Destée MD, PhD & L. Defebvre MD,PhD

  2. Department of Gait Analysis, Lille University, Medical Centre, Lille, France

    P. Krystkowiak MD, PhD, A. Delval MD, S. Bleuse PhD, J. L. Blatt MD, PhD, J. L. Bourriez PhD, P. Derambure MD, PhD, A. Destée MD, PhD & L. Defebvre MD,PhD

  3. Clinical Neurophysiology, Lille University, Medical Centre, Lille, France

    A. Delval MD, J. L. Blatt MD, PhD, J. L. Bourriez PhD & P. Derambure MD, PhD

Authors
  1. P. Krystkowiak MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Delval MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. K. Dujardin PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S. Bleuse PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. J. L. Blatt MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J. L. Bourriez PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. P. Derambure MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. A. Destée MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. L. Defebvre MD,PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to P. Krystkowiak MD, PhD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Krystkowiak, P., Delval, A., Dujardin, K. et al. Gait abnormalities induced by acquired bilateral pallidal lesions. J Neurol 253, 594–600 (2006). https://doi.org/10.1007/s00415-006-0066-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00415-006-0066-6

Key words

Search

Navigation