Klinische Neurophysiologie 2011; 42 - P270
DOI: 10.1055/s-0031-1272717

Gait and posture in pre-manifest and symptomatic huntington's disease

H. Beckmann 1, S. Rumpf 1, N. Bechtel 1, H.W. Lange 1, C. Saft 1, R. Hoffmann 1, P. Kraus 1, K. Barth 1, S. Trautmann 1, B. Landwehrmeyer 1, R. Reilmann 1
  • 1Münster, Bochum, Ulm

Background: HD patients develop impairment of balance & gait, frequently resulting in injuries. Quantitative assessment of gait and balance may serve as surrogate marker for motor dysfunction.

Object: Can GAITRite(GR) & Force Plate(FP)detect motor deficits in premanifest HD (pHD, do deficits correlate to severity of phenotype as assessed by UHDRS-TMS, TFC and FA?

Subject: Symptomatic HD (sHD) patients (n=40), pHD (n=26) & controls (n=30) were (1) placed on FP with eyes open & closed for 25s. Subjects were instructed to stand still. Stability of center of mass (COM) location was assessed by variables SURFACE, VELOCITY, and DISTANCE. They were (2) instructed to walk down GR in conditions „slow“ and „fast“ walking. Parameters assessed were VELOCITY, STRIDE LENGTH, DOUBLE SUPPORT, COEFFICIENT OF STRIDE LENGTH. Non-parametric statistics were performed to compare groups (Mann-Whitney-Test) and to assess dependent variables (Wilcoxon-Test). Correlation analysis was performed by non-parametric Spearman correlations.

Results: FP measures DISTANCE & VELOCITY discriminate between controls, pHD and sHD in EYES OPEN and EYES CLOSED condition. SURFACE cannot, in either condition, separate controls from pHD. In pooled group of pHD and sHD, all clinical assessments correlate to all FP measures. In separate sHD group, FP measure SURFACE EYES OPEN correlates to severity of disease as assessed in UHDRS-TMS, TFC and FA, EYES OPEN VELOCITY and DISTANCE, EYES CLOSED SURFACE and DISTANCE correlate to Burden of Disease (BOD). Only EYES CLOSED DISTANCE correlates to severity of disease in TFC in pHD group.

Among GR measures, only slow DOUBLE SUPPORT discriminates between controls and pHD, slow VELOCITY and STRIDE LENGTH, and slow and fast DOUBLE SUPPORT discriminate between controls and sHD, slow VELOCITY and STRIDE LENGTH, fast VELOCITY, STRIDE LENGTH, and COEFFICIENT OF STRIDE LENGTH VARIABILITY discriminate between pHD and sHD. In pooled group, slow VELOCITY and slow STRIDE LENGTH correlate to UHDRS. Fast VELOCITY correlates to severity of disease in all assessments. Fast STRIDE LENGTH correlates to UHDRS and FA. In separate groups, only fast VELOCITY correlates to UHDRS-TMS in pHD and sHD, it correlates to FA in sHD. Fast DOUBLE SUPPORT correlates to TFC and FA in sHD.

Conclusions: Assessment with GR & FP provides objective and quantitative readouts of motor dysfunction in HD. Sensitivity in pre-manifest stage and phenotype correlation with UHDRS-TMS suggests better performance of FP.