Dreidimensionale ultraschallgestützte Ganganalyse bei schizophrenen Patienten

Zusammenfassung

Räumliche und zeitliche Gangparameter schizophrener Patienten wurden im intraindividuellen zweizeitigen Vergleich analysiert: in Gruppe 1 (n = 14) unter konventioneller neuroleptischer Therapie und nach Umstellung auf Olanzapin, in Gruppe 2 (n = 12) im neuroleptikanaiven Status und unter Therapie mit Olanzapin. In Gruppe 1 war die unter Therapie mit Olanzapin gemessene Gehgeschwindigkeit höher (p ≤ 0,01) und die Schrittlänge größer (p ≤ 0,01) als unter konventioneller Therapie. Signifikante Unterschiede in der Schrittfrequenz (Kadenz) waren nicht nachweisbar. In Gruppe 2 zeigten sich unter Behandlung mit Olanzapin keine signifikanten Veränderungen der gemessenen Gangparameter im Vergleich zum neuroleptikanaiven Zustand.

Abstract

Schizophrenic disorders as well as neuroleptic treatment can affect locomotion. The study assessed the influence of neuroleptic treatment on human gait via ultrasonic topometric gait analysis. In a control sample the test system proved high test-retest-reliability. Spatial and temporal gait parameters were assessed in schizophrenic patients without neuroleptic treatment (n = 12) and under treatment with conventional neuroleptics (n = 14) and re-assessed after treatment change to the atypical neuroleptic olanzapine in a repeated measures design. After switch from conventional neuroleptics to olanzapine patients showed an increase of gait velocity (p ≤ 0.01) and step length (p ≤ 0.01) whereas the cadence remained stable. Significant differences between the untreated state and treatment with olanzapine were not detectable. We conclude that bipedal gait is affected by conventional neuroleptic treatment. The degree of impairment can be objectively measured by testing spatio-temporal and kinematic gait parameters via three-dimensional ultrasonic gait analysis.

Literatur

• 1 McCreadie R G, Hall D J, Berry I J, Robertson L J, Ewing J I, Geals M F. The Nithsdale schizophrenia surveys. X: Obstetric complications, family history and abnormal movements.  Br J Psychiatry. 1992;  160 799-805
• 2 Whitworth A B, Fleischhacker W W. Adverse effects of antipsychotic drugs.  Int Clin Psychopharmacol. 1995;  9, Suppl 5 21-27
• 3 Moeller H. Aktuelle Bewertung neuer/atypischer Neuroleptika.  Nervenarzt. 2000;  71 329-344
• 4 Chouinard G, Jones B, Remington G, Bloom D, Addington D, MacEwan G W, Labelle A, Beauclair L, Arnott W. A Canadian multicenter placebo-controlled study of fixed doses of risperidone and haloperidol in the treatment of chronic schizophrenic patients (published erratum appears in J Clin Psychopharmacol 1993 Apr; 13 [2]: 149) (see comments).  J Clin Psychopharmacol. 1993;  13 25-40
• 5 Simpson G M, Angus J W. A rating scale for extrapyramidal side effects.  Acta Psychiatr Scand Suppl. 1970;  212 11-19
• 6 Obens T. Gait analysis and plantar pressure distribution measurement.  Orthopädie-Technik. 2000;  9 798-806
• 7 Vogt L, Banzer W. Measurement of lumbar spine kinematics in incline treadmill walking.  Gait Posture. 1999;  9 18-23
• 8 Vogt L, Pfeifer K, Banzer W. Application of modern methods of movement analysis for functional diagnosis and risk screening of the athlete.  Sportverletz Sportschaden. 2001;  15 M33-M36
• 9 Messsystem zur 3D-Bewegungsanalyse CMS 70 P: Technische Anleitung mit Prüfberichten. 2000
• 10 Putzhammer A. Three-dimensional ultrasonic gait analysis in schizophrenic patients: treatment with conventional neuroleptics versus treatment with olanzapine.  Pharmacopsychiatry. 2002;  34 194-200
• 11 Neumann D, Vogt L, Banzer W, Schreiber U. Kinematic and neuromuscular changes of the gait pattern after Achilles tendon rupture.  Foot Ankle Int. 1997;  18 339-341
• 12 Portscher M, Vogt L, Pfeifer K, Banzer W. Reproducibility of lumbar spine kinematics in clinical gait analysis.  Sportverletz Sportschaden. 2000;  14 50-54
• 13 Vogt L, Banzer W. Measurement of lumbar spine kinematics in incline treadmill walking.  Gait Posture. 1999;  9 18-23
• 14 Beasley C M, Tollefson G, Tran P, Satterlee W, Sanger T, Hamilton S. Olanzapine versus placebo and haloperidol: acute phase results of the North American double-blind olanzapine trial (see comments).  Neuropsychopharmacology. 1996;  14 111-123
• 15 Masand P S, Berry S L. Switching antipsychotic therapies.  Ann Pharmacother Febr. 2000;  34 200-207
• 16 Hassin-Baer S, Sirota P, Korczyn A D, Treves T A, Epstein B, Shabtai H, Martin T, Litvinjuk Y, Giladi N. Clinical characteristics of neuroleptic-induced parkinsonism.  J Neural Transm. 2001;  108 1299-1308
• 17 Blin O, Ferrandez A M, Pailhous J, Serratrice G. Dopa-sensitive and dopa-resistant gait parameters in Parkinson's disease.  J Neurol Sci. 1991;  103 51-54
• 18 Morris M E, Iansek R, Matyas T A, Summers J J. The pathogenesis of gait hypokinesia in Parkinson's disease.  Brain. 1994;  117 (Pt 5) 1169-1181
• 19 Morris M E, Iansek R, Matyas T A, Summers J J. Ability to modulate walking cadence remains intact in Parkinson's disease.  J Neurol Neurosurg Psychiatry. 1994;  57 1532-1534
• 20 Flyckt L, Sydow O, Bjerkenstedt L, Edman G, Rydin E, Wiesel F A. Neurological signs and psychomotor performance in patients with schizophrenia, their relatives and healthy controls.  Psychiatry Res. 1999;  86 113-129
• 21 Fuller R, Nathaniel-James D, Jahanshahi M. Movement-related potentials prior to self-initiated movements are impaired in patients with schizophrenia and negative signs.  Exp Brain Res. 1999;  126 545-555
• 22 Jahanshahi M, Frith C D. Willed action and its impairments.  Cognitive Neuropsychol. 1998;  15 483-533