Objective: In patients with Parkinson’s disease (PD), deep brainstimulation of the subthalamic nucleus (STN DBS) is well recognizedin improving limb function, but the outcome on swallowing functionhas rarely been studied. The aim of this work was to evaluate theeffect of STN DBS on pharyngeal swallowing function in patientswith PD using self-estimation and fiberoptic endoscopic evaluation ofswallowing. Methods: Eleven patients (aged 41–72, median 61 years)were evaluated preoperatively and at 6 and 12 months after STN DBSsurgery. All patients were evaluated with self-estimation on a visualanalogue scale, and eight of them with a fiberoptic endoscopicexamination with a predefined swallowing protocol includingRosenbek’s Penetration-Aspiration Scale, Secretion Severity Scale,preswallow spillage, pharyngeal residue, and pharyngeal clearance. Results: The self-assessments of swallowing function revealed asubjective improvement with STN DBS stimulation, whereas the datafrom the swallowing protocol did not show any significant effect ofthe STN DBS treatment itself. The prevalence of aspiration was notaffected by the surgery. Conclusions: The results show thatswallowing function was not negatively affected by STN DBS and therisk of aspiration did not increase. Self-estimation of swallowingfunction showed a subjective improvement due to stimulation / Speech, voice and swallowing outcomes after deep brain stimulation (DBS)

Il a été montré que la lésion du noyau subthalamique (NST) était impliqué dans la motivation en augmentant cette dernière pour la nourriture et la réduisant pour la cocaïne. On sait aussi que le NST est impliqué dans des processus émotionnels. La notion de motivation est difficilement dissociable de celle de plaisir. Le premier objectif de ce travail de thèse a donc été de séparer la motivation du plaisir pour mieux comprendre le role du NST sur les processus hédoniques grâce à des expériences de choix entre une récompense hédonique (saccharine) et une récompense calorique (glucose) puis des expériences de choix entre nourriture et cocaïne. Dans un second temps nous avons étudié le rôle du NST dans l’influence du contexte social sur la prise de cocaïne. Il parait assez évident de penser que l’addiction aux drogues se développe la plupart du temps dans un contexte social. Cependant, bien que le contexte social global ait beaucoup été étudié, c’est seulement récemment que les modèles animaux d’addiction en neurosciences ont intégré le rôle des facteurs sociaux proximaux (FSP, ceux présents au moment de l’exposition aux drogues), sans pour autant en étudier les bases neurobiologiques. On sait que la présence d’un congénère mais aussi son comportement influence le comportement d’auto-administration de drogue d’un individu. Cependant, les études menées dans ce cadre ne se sont pas intéressées au substrat neurobiologique de ces modulations comportementales. Ainsi, la suite de ce travail de thèse s’est attaché à étudier le rôle du noyau subthalamique sur l’influence des FSP dans la prise de cocaïne. / It has been shown that subthalamic nucleus (STN) is involved in motivation, increasing it for food, while decreasing it for cocaine. It has also been shown that STN is involved in emotional processes. The idea of motivation is hardly dissociable from the notion of pleasure. We currently know the role of STN in motivation, but not so much has been done regarding its implication in hedonic processes. The first aim of my work was to separate motivation from pleasure to better understand the role of STN in hedonic processes, using choice procedures between hedonic (saccharine) and caloric reward (glucose), and between food or cocaine. We wanted thus to understand better the role of STN in the modulation exerted by the context, especially the social context, on cocaine intake. We know that drug addiction often develops in a social context. However, even if global social context has been studied a lot, it is only since recently that animal studies have taken into account the role of proximal social factors (PSF, those that are immediately present at the time of drug exposure). However, these studies do not provide any information regarding neurobiological basis. Here, we examine how PSF interact with the STN, in the context of cocaine intake. Altogether, these results contribute to a better understanding of the STN involvement in the control of pleasure. Moreover, they provide evidence of the influence of proximal social factors on drug consumption and its neurobiological basis among which the STN seems to play a critical role.

Introdução: A estimulação cerebral profunda (DBS) tem sido utilizada para controle das alterações motoras nos pacientes com Doença de Parkinson (DP). O núcleo subtalâmico (NST) é o alvo preferencialmente escolhido na cirurgia. Entretanto, a técnica tem sido associada com declínio cognitivo, principalmente na fluência verbal, alterações de humor e de comportamento. Objetivo: Verificar a ocorrência de alterações na cognição, humor e atividades funcionais por meio de avaliação neuropsicológica. Métodos: Vinte e um pacientes submetidos à cirurgia no período de Maio de 2008 a Março de 2013 foram examinados por meio da avaliação neuropsicológica incluindo testes de memória, funções executivas, funções atencionais, linguagem, praxia, escala hospitalar de depressão e ansiedade (HADS) e atividades funcionais (Pfeffer), nas fases pré e pós-operatória. Os dados foram analisados utilizando SPSS versão 17.0 e os resultados foram comparados através do teste pareado t-Student ou chi-quadrado. Foi adotado um nível de significância igual ou menor que 5% (p < 0,05) para todas as análises. Resultados: Não foram encontradas diferenças significativas nas funções cognitivas, no humor e nas atividades funcionais avaliadas. Resultado marginal foi observado na memória episódica imediata verbal (p=0,051). Conclusão: DBS-NST parece não ter impacto negativo nas funções cognitivas e humor. Apesar da amostra ser relativamente pequena, a técnica parece ser segura do ponto de visto cognitivo em pacientes adequadamente selecionados / Introdution: Deep brain stimulation (DBS) has been used for control of motor disorders in patients with Parkinson\'s disease (PD). The subthalamic nucleus (STN) is the main target used in surgery. However, the technique has been associated with cognitive decline, mainly in verbal fluency, mood and behavior. Objective: To investigate the occurrence of changes in cognition, mood, and activities of daily living through neuropsychological assessment. Methods: Twenty one patients operated between May, 2008 and March, 2013 were submitted to pre- and post-operative neuropsychological testing including memory, executive functions, attentional functions, language and praxis assessment, and to hospital anxiety and depression scale (HADS) and activities of daily living (Pfeffer) scale rating as well. Data were analyzed using SPSS version 17.0 and the results were compared using the paired Student t-test or chi-square. A significance level equal or lower than 5% (p < 0.05) was adopted. Results: No significant differences were found in cognitive functions, mood and activities of daily living. Marginal results were observed in immediate verbal episodic memory (p=0.051). Conclusion: DBS - STN did not show a negative impact on cognitive function, mood and daily activities. Despite the relatively small sample, the technique appears to be safe from the cognitive point of view in appropriately selected patients

Abstract Deep brain stimulation (DBS) of the subthalamic nucleus (STN) has been gaining importance in the treatment of advanced Parkinson's disease. This study was undertaken to evaluate the beneficial effects of bilateral STN stimulation on patient's clinical symptoms and quality of life related to the potential risks and side effects of the treatment. A consecutive series of 42 patients operated on for Parkinson's disease with STN DBS in Oulu University Hospital were included. A subgroup of these patients was evaluated using the Unified Parkinson's Disease Rating Scale (UPDRS), neuropsychological tests, and Health Related Quality of Life (HRQoL) instruments i.e. the Parkinson's Disease Questionnaire (PDQ-39) and the Finnish version of the Nottingham Health Profile (NHP). The costs of the treatment were calculated from the perspective of the health care provider. The possible effects of bilateral STN-operation on cardiovascular autonomic function were analyzed by measuring various time- and frequency domain indexes as well as non-linear indexes of heart rate variability (HRV) from 24-hour EKG recording before and 12 months after the operation. This study showed that STN DBS significantly improves the clinical symptoms and HRQoL of parkinsonian patients. The dyskinesia and clinical fluctuation scores were reduced very significantly in the UPDRS IV subscale. The clinical fluctuations were reduced by 53 %. After DBS best motor response (UPDRS III) scores also improved significantly. The HRQoL measured with both instruments improved significantly. Improvement was seen in the PDQ-39 summary index and the subscales of activities of daily living, emotional well-being, stigma and bodily discomfort. Only communication became worse during the follow-up. There was a statistically significant improvement in the score of the subscales of NHP measuring problems with energy, sleep, emotional reactions and social isolation. One patient died from pulmonary embolism and another contracted a late postoperative intracerebral hemorrhage leading to a permanent deterioration of her neurological condition to the bedridden stage. Other complications were much milder. Clinical improvement and improvement in HRQoL were positively correlated. STN DBS does not influence tonic autonomic cardiovascular regulation. The incremental costs of performing bilateral STN DBS in Finland compared to preoperative medical treatment amounted to an average of 25 591 EUR per patient during the first postoperative year. The majority of parkinsonian patients experienced significant and long lasting relief in their motor symptoms and an improvement in HRQoL following STN stimulation.

Les noyaux gris centraux (ganglions de la base en anglais) sont un réseau de structures sous-corticales dont la persistance dans l'ensemble des vertébrés plaide en faveur d'une fonction clef au cours de l'évolution. Comme ce fut remarqué dès le 18ème siècle, ils ont l'unique particularité de concentrer des afférences de l'entièreté de la surface corticale. Cette position centrale et l'analyse de l'anatomie du réseau leur ont valu le rôle d'arbitre central du cerveau, réglant les conflits entre processus neuronaux concomitants bien qu'incompatibles. Au sein du réseau, le noyau subthalamique jouit d'une notoriété particulière. Ce noyau, sur la base de ses afférences corticales, et en vertu de ses projections sur le soma des neurones pallidaux, aurait pour fonction de filtrer les programmes comportementaux codés par le striatum et concourant pour leur expression. Rapporté aux théories de la prise de décision, le noyau subthalamique fixerait le seuil décisionnel, ou la quantité d'information à accumuler en faveur d'une option comportementale afin qu'elle soit exprimée. Mais si ce petit noyau est devenu si célèbre, c'est surtout qu'il est la cible d'une procédure chirurgicale spectaculaire: la stimulation cérébrale profonde. Cette opération du cerveau est le dernier recours pour les patients souffrant d'une maladie de Parkinson ou d'un trouble obsessionnel compulsif sévère. Elle parvient même parfois à faire disparaître leurs symptômes. Malgré cette efficacité remarquable, les mécanismes de la stimulation cérébrale profonde restent inconnus. Il faut, entre autres, blâmer l'obscurité qui règne encore sur le noyau subthalamique, car les fonctions mentionnées ci-dessus restent des conjectures théoriques en manque de validation expérimentale. La première étape de ce travail a été d'en valider les bases anatomiques. En effet, l'existence d'une voie fronto-subthalamique - nécessaire au modèle - n'était connue que sur la base d'études menées chez le rat. Nous avons démontré, par des méthodes de traçage axonal, l'existence de cette connexion chez le primate. En sus, cette connexion aura permis de redéfinir les frontières médiales du noyau subthalamique avec les conséquences cliniques qui peuvent en être tirées. Le deuxième objectif global de cette thèse était de tester la validité fonctionnelle du modèle, la stimulation cérébrale profonde offrant un accès rare aux activités du noyau subthalamique. Cependant, il était d'abord nécessaire de caractériser la population étudiée, à savoir des patients souffrants d'un trouble obsessionnel compulsif. Grâce à l'imagerie de diffusion nous démontrons une diminution ainsi qu'une désorganisation des connexions cortico-sous corticales, se traduisant probablement par un défaut de contrôle conscient sur le processus de sélection. Une étude de magnétoencéphalographie est en cours pour approfondir les changements d'activité corticale. Pour tester le rôle du noyau subthalamique dans l'établissement du seuil décisionnel nous avons enregistré son activité électrophysiologique pendant que les patients effectuaient une tâche de prise de décision perceptuelle. Nous démontrons que les neurones du noyau subthalamique ont une réponse multimodale, concordant en cela avec nos données anatomiques qui montrent une convergence d'informations au niveau du noyau subthalamique. De plus, une augmentation de l'activité est retrouvée dans les conditions attendues... / The basal ganglia are a network of subcortical structures of which the invariant architecture throughout vertebrate evolution suggests a key function in evolution. As was noted as early as the 18th century, they have the unique characteristic of concentrating afferences from the entire cortical surgace. Given this central position and the internal architecture of the network, they could provide a centralised selection mechanism in the brain, arbitrating between any two conflicting processes. Among the basal ganglia, the subthalamic nucleus has become of particular interest as it is the target of deep brain stimulation, a neurosurgical procedure used to treat severe Parkinson’s disease and obsessive-compulsive disorder. It would have for function to integrate contextual information from its cortical inputs to filter behavioural programs encoded by the striatum. Within the framework of decision-making models, this filtering function is akin to setting the decision threshold, or the amount of evidence required before selecting a program. However, this considerations remain hypothetical as they are lacking experimental support. The first objective of this work was to validate the anatomical basis of these assumptions. Indeed, the existence of a prefrontal-subthalamic pathway, necessary to expand the decision models to every type of decision, had only been demonstrated in rodents. We demonstrated its existence in the primate using anterograde axonal tracing. In addition, this projection will have allowed us to redefine the medial border of the subthalamic nucleus with the clinical consequences that that may have. The second objective of this thesis was to test the functional validity of the models, and specifically the role of the subthalamic nucleus in setting decision thresholds. Deep brain stimulation offers a rare access to the electrophysiology of this structure; however, it is a patient population, here obsessive-compulsive disorder patients. A first step was, therefore, to characterise this population, anatomically and behaviourally, to understand how it might be of use as a model of decision-making in the basal ganglia. We demonstrated a reduction in the strength of cortico-subcortical anatomical connections. We suggest that this prevents accurate conscious control over decision mechanisms. Behaviourally, patients displayed a pathologically low confidence levels in their decisions and we hypothesised that this would lead to an increase of the decision threshold and matching subthalamic activity. To test this, we recorded the activity of the subthalamic nucleus during a decision-making task. We demonstrate that subthalamic neurons have a multimodal activity, consistent with our demonstration of convergent cortical inputs. However, we were unable to demonstrate a link between subthalamic activity and decision threshold, although this may be due to technical considerations…

No description available.

Deep brain stimulation (DBS) of the subthalamic nucleus (STN) and DBS of the pedunculopontine nucleus (PPN) have been shown to be effective surgical therapies for Parkinson’s disease (PD). To better understand the PPN and STN as DBS targets for PD, this research compares the anatomy, electrophysiology, and motor control roles of these nuclei. PPN and STN connections were examined in vivo in human subjects and in the non-human primate using probabilistic diffusion tractography. Both the PPN and STN were connected with each other and with the motor cortex (M1) and basal ganglia. After studying these anatomical connections in primates, their functional significance was further explored in an anesthetized rat model of PD. Examination of the electrophysiological relationship between the PPN and basal ganglia in the presence of slow cortical oscillatory activity suggested that excitatory input from the STN may normally modulate PPN spike timing but that inhibitory oscillatory input from the basal ganglia output nuclei has a greater effect on PPN spike timing in the parkinsonian brain. To examine transmission and modulation of oscillatory activity between these structures at higher frequencies, LFP activity was recorded from the PPN and STN in PD patients performing simple voluntary movements. Movement-related modulation of oscillatory activity predominantly occurred in the α (8-12 Hz) and low β (12-20 Hz) frequencies in the STN but in the high β (20-35 Hz) frequencies in the PPN, supporting observations from rodent studies suggesting that oscillatory activity is not directly transmitted from the STN to the PPN in PD. Finally, to better understand the roles of the STN and PPN in large-scale movement, the effects of STN and PPN DBS on gait abnormalities in PD patients were studied. DBS of the STN appeared to improve gait by optimising executive gait control while DBS of the PPN appeared to restore autonomic gait control. These results have several implications for DBS patient selection, surgical targeting, and for understanding the mechanisms underlying DBS efficacy.

This thesis is concerned with the neurocircuitry that underpins the cardiovascular response to exercise, which has thus far remained incompletely understood. Small animal studies have provided clues, but with the advent of functional neurosurgery, it has now been made possible to translate these findings to humans. Chapter One reviews the background to the studies in this thesis. Our current understanding of the cardiovascular response to exercise is considered, followed by a discussion on the anatomy and function of various brain nuclei. In particular, the rationale for targeting the periaqueductal grey (PAG) and the subthalamic nucleus (STN) is reviewed. Chapter Two reviews the use of deep brain stimulation (DBS), in which deep brain stimulating electrodes are implanted into various brain nuclei in humans, in order to treat chronic pain and movement disorders. This technique not only permits direct electrical stimulation of the human brain, but also gives the opportunity to record the neural activity from different brain regions during a variety of cardiovascular experiments. This chapter also gives a detailed methodological description of the experimental techniques performed in the studies in this thesis. Chapter Three identifies the cardiovascular neurocircuitry involved in the exercise pressor reflex in humans using functional neurosurgery. It shows for the first time in humans that the exercise pressor reflex is associated with significantly increased neural activity in the dorsal PAG. The other sites investigated, which had previously been identified as cardiovascular active in both animals and humans, seem not to have a role in the integration of this reflex. Chapter Four investigates whether changes in exercise intensity affect the neurocircuitry involved in the exercise pressor reflex. It demonstrates that the neural activity in the PAG is graded to increases in exercise intensity and corresponding increases in arterial blood pressure. This chapter also provides evidence to suggest that neural activity in the STN corresponds to the cardiovascular changes evoked by the remote ischaemic preconditioning stimulus in humans. Chapter Five identifies the cardiovascular neurocircuitry involved during changes in central command during isometric exercise at constant muscle tension using muscle vibration. It shows that, in humans, central command is associated with significantly decreased neural activity in the STN. Furthermore, the STN is graded to the perception of the exercise task, i.e. the degree of central command. The other sites investigated appear not to have as significant a role in the integration of central command during the light exercise task that was undertaken. Chapter Six studies the changes in muscle sympathetic nerve activity (MSNA) during stimulation of various brain nuclei in humans. Regrettably, the results presented in this chapter are not convincing enough to support the hypothesis that stimulation of particular subcortical structures corresponds to changes in MSNA. However, the cardiovascular changes that were recorded during stimulation of the different subcortical structures are congruous with previous studies in both animals and humans. Chapter Seven presents a brief summary of the findings in this thesis.

L’efficacité de la stimulation cérébrale profonde subthalamique dans certains cas de maladie de Parkinson est maintenant bien établie. Toutefois, des progrès restent possibles, à la fois en terme de contrôle du geste chirurgical et en terme de définition de la cible chirurgicale. Dans la première partie de ce travail, nous nous sommes intéressés à l’optimisation du contrôle de l’implantation des électrodes de stimulation cérébrale profonde. Nous avons tout d’abord analysé rétrospectivement les résultats obtenus en réalisant une imagerie tridimensionnelle per-opératoire pour le contrôle de positionnement des électrodes. Nous nous sommes ensuite intéressés à la possibilité d’utiliser un repère de visée radiologique per-opératoire. Nous avons revu pour cela une série de patients ayant subi une réimplantation d’électrodes, pour lesquels l’électrode déjà en place était utilisée comme point de repère à la fois pour définir la cible de la réimplantation et pour contrôler radiologiquement l’implantation de la nouvelle électrode. Dans la seconde partie, nous avons travaillé à l’optimisation de la cible subthalamique. Nous avons tout d’abord évalué la pertinence du repérage du faisceau mamillo-thalamique sur des coupes IRM axiales comme marqueur de la coordonnée y du bord antérieur du noyau subthalamique. Ensuite, nous avons tâché de proposer une normalisation tridimensionnelle de l’espace stéréotaxique à partir de données recueillies dans une série de volontaires sains. Enfin, pour une série de patients opérés avec un bon résultat, nous avons cherché à corréler la position des contacts actifs en stimulation chronique avec des points de repères profonds visibles en IRM. Nous avons pu proposer ainsi une cible normalisée dont les coordonnées sont : x = 0,44xbord latéral du V3 + 10,71mm; y = 0,69xfaisceau mamillothalamique + 1,62 mm ou 0,34 distance CACP + 2,52 mm; z = 0,72 hauteur du thalamus – 16 mm. Cette cible sera évaluée dans une future étude prospective. / The clinical efficacy of subthalamic deep brain stimulation is now well established. Nevertheless, progress is possible, regarding especially (1) the accuracy of electrodes implantation and (2) the definition of the surgical target. In the first part of this work, we worked on the optimization of DBS electrodes implantation. First, we analyzed retrospectively the results obtained by using intra-operative 3D imaging for the control of microelectrodes and definite leads placement. Thereafter, we considered the possibility to use a radiological landmark for intraoperative controls. To this end, we studied the cases of patients who underwent reimplantation of DBS electrodes. The initial electrode (still implanted) was used as a landmark: (1) for the deifntion of the reimplantation target and (2) for the radiological control of the new lead positioning. In the second part, we worked on the optimization of the surgical target. First, we assessed the interest of the mamillothalamic tract as a landmark of the anteroposterior coordinate of the anterior border of the STN in MR axial images. Thereafter, we tried to identify MR landmarks for tridimensionnal normalization of the stereotactic space. Finally, we tried to correlate the coordinates of active contacts with MR-defined landmarks in a series of patients that had been operated with good clinical results. Based on our results, we can propose the following coordinates for a new normalized subthalamic target : x = 0.44xlat edge 3rd ventricle + 10.71mm; y = 0.69xmamillo-thalamic tract + 1.62 mm or 0.34 ACPC length + 2.52 mm; z = 0.72xthalamus height – 16 mm. We will assess this target in a future prospective study.

Introdução: A disfunção da marcha é um dos maiores comprometimentos funcionais do paciente com a doença de Parkinson (DP). A estimulação cerebral profunda do núcleo subtalâmico tem mostrado melhora da marcha e equilíbrio. Esse efeito pode ser mantido e potencializado por programas de reabilitação motora específicos, como o treino em esteira sem e com suporte de peso corporal. No entanto, faltam estudos desses treinos em pacientes com a DP em uso desta estimulação. Objetivo: Comparar parâmetros cinemáticos lineares e angulares da marcha de pacientes com a DP em uso de estimulação cerebral profunda bilateral do núcleo subtalâmico, antes e após dois treinamentos: esteira sem e com suporte de peso corporal, associados à cinesioterapia convencional. Métodos: 12 pacientes (60,9 ± 10,6 anos; 20 ± 7 anos de doença e 20 ± 4 meses de tempo de cirurgia) completaram ambos os treinos em estudo cruzado fixo. Os pacientes passaram por 8 semanas de treino de marcha em esteira sem suporte de peso corporal e programa de cinesioterapia convencional, seguidas por 6 semanas de período sem intervenção. Posteriormente, realizaram 8 semanas de treino de marcha em esteira com suporte de peso corporal e o mesmo programa de cinesioterapia regular. As intervenções tiveram frequência de duas vezes por semana e duração de 90 minutos por sessão. A análise cinemática da marcha envolveu oito câmeras infravermelhas que detectaram 19 marcadores reflexivos nos membros inferiores dos pacientes. A análise estatística utilizou o teste Wilcoxon e foi adotado valor de p <= 0,05 como estatisticamente significante. Resultados: Ambos os treinos não mostraram diferenças significativas nos parâmetros lineares. Após o treino com suporte, observou-se aumento significativo dos seguintes parâmetros angulares: amplitude de movimento da pelve (inclinação, obliquidade e rotação); amplitude de movimento do quadril (abduçãoadução e rotação); % da fase de balanço que corresponde à flexão máxima do joelho e amplitude de movimento da progressão do pé. Conclusão: O treino em esteira com suporte de peso corporal mostrou capacidade de promover mudanças em parâmetros cinemáticos angulares da marcha. As implicações do treino em suspensão podem ter sido somadas aos efeitos neurofisiológicos da estimulação cerebral profunda e então desencadeado a melhora da mobilidade dos membros inferiores durante a marcha / Introduction: Gait disturbance is one of the hallmark features of Parkinson\'s disease (PD). Subthalamic nucleus deep brain stimulation (DBS) has shown improvements in gait and balance, and this effect can be maintained and enhanced by specific motor rehabilitation programs, such treadmill training without and with body weight support. However, at present there is a paucity of research on these combined interventions in PD with of this stimulation. Objective: To compare training-induced changes in gait linear and angular kinematic parameters among patients with PD who have used bilateral subthalamic nucleus DBS, and a combined intervention of conventional physical therapy with either treadmill training with body weight support or without support. Methods: 12 patients (age: 60.9 ± 10.6 years; disease duration: 20 ± 7 years; and time since DBS surgery: 20 ± 4 months) completed both training protocols in a fixed cross-over design. All patients received 8 weeks of treadmill training without body weight support in conjunction with conventional physical therapy, followed by a 6 weeks wash out period of no training. Thereafter, all patients received 8 weeks of body weight support treadmill training, in conjunction with the same conventional physical therapy. Both interventions had a frequency of two times per week, and duration of 90 minutes per session. Gait kinematic analysis involved eight infrared cameras that detected 19 reflective spherical markers attached to the limb lower of patients. Statistical analysis used the Wilcoxon and was adopted the value of p <= 0,05 as statistically significant. Results: Both the training no showed significant differences in linear parameters. After the body weight support training, observed there was a significant increase in following angular parameters: pelvis\' range of motion (tilt, obliquity, rotation); hip\'s range of motion (abduction-adduction and rotation); % Knee maximal flexion on Swing phase and foot progression\' range of motion. Conclusion: Treadmill training with body weight support showed an ability to promote changes in gait angular kinematic parameters. The implications of this training may have been added to the neurophysiological effects of DBS and then triggered the improved of mobility of lower limbs during gait