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Endepols H, Apetz N, Vieth L, Lesser C, Schulte-Holtey L, Neumaier B, Drzezga A. Cerebellar Metabolic Connectivity during Treadmill Walking before and after Unilateral Dopamine Depletion in Rats. Int J Mol Sci 2024; 25:8617. [PMID: 39201305 PMCID: PMC11354914 DOI: 10.3390/ijms25168617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Revised: 07/26/2024] [Accepted: 08/05/2024] [Indexed: 09/02/2024] Open
Abstract
Compensatory changes in brain connectivity keep motor symptoms mild in prodromal Parkinson's disease. Studying compensation in patients is hampered by the steady progression of the disease and a lack of individual baseline controls. Furthermore, combining fMRI with walking is intricate. We therefore used a seed-based metabolic connectivity analysis based on 2-deoxy-2-[18F]fluoro-D-glucose ([18F]FDG) uptake in a unilateral 6-OHDA rat model. At baseline and in the chronic phase 6-7 months after lesion, rats received an intraperitoneal injection of [18F]FDG and spent 50 min walking on a horizontal treadmill, followed by a brain PET-scan under anesthesia. High activity was found in the cerebellar anterior vermis in both conditions. At baseline, the anterior vermis showed hardly any stable connections to the rest of the brain. The (future) ipsilesional cerebellar hemisphere was not particularly active during walking but was extensively connected to many brain areas. After unilateral dopamine depletion, rats still walked normally without obvious impairments. The ipsilesional cerebellar hemisphere increased its activity, but narrowed its connections down to the vestibulocerebellum, probably aiding lateral stability. The anterior vermis established a network involving the motor cortex, hippocampus and thalamus. Adding those regions to the vermis network of (previously) automatic control of locomotion suggests that after unilateral dopamine depletion considerable conscious and cognitive effort has to be provided to achieve stable walking.
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Affiliation(s)
- Heike Endepols
- Institute of Radiochemistry and Experimental Molecular Imaging, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany (L.V.)
- Nuclear Chemistry (INM-5), Institute of Neuroscience and Medicine, Forschungszentrum Jülich GmbH, Wilhelm-Johnen-Straße, 52428 Jülich, Germany
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany;
| | - Nadine Apetz
- Institute of Radiochemistry and Experimental Molecular Imaging, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany (L.V.)
| | - Lukas Vieth
- Institute of Radiochemistry and Experimental Molecular Imaging, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany (L.V.)
| | - Christoph Lesser
- Institute of Radiochemistry and Experimental Molecular Imaging, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany (L.V.)
| | - Léon Schulte-Holtey
- Institute of Radiochemistry and Experimental Molecular Imaging, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany (L.V.)
| | - Bernd Neumaier
- Institute of Radiochemistry and Experimental Molecular Imaging, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany (L.V.)
- Nuclear Chemistry (INM-5), Institute of Neuroscience and Medicine, Forschungszentrum Jülich GmbH, Wilhelm-Johnen-Straße, 52428 Jülich, Germany
| | - Alexander Drzezga
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany;
- German Center for Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany
- Molecular Organization of the Brain (INM-2), Institute of Neuroscience and Medicine, Forschungszentrum Jülich GmbH, Wilhelm-Johnen-Straße, 52428 Jülich, Germany
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Maas SA, Göcking T, Stojan R, Voelcker-Rehage C, Kutz DF. Synchronization of Neurophysiological and Biomechanical Data in a Real-Time Virtual Gait Analysis System (GRAIL): A Proof-of-Principle Study. SENSORS (BASEL, SWITZERLAND) 2024; 24:3779. [PMID: 38931563 PMCID: PMC11207734 DOI: 10.3390/s24123779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 06/04/2024] [Accepted: 06/07/2024] [Indexed: 06/28/2024]
Abstract
The investigation of gait and its neuronal correlates under more ecologically valid conditions as well as real-time feedback visualization is becoming increasingly important in neuro-motor rehabilitation research. The Gait Real-time Analysis Interactive Lab (GRAIL) offers advanced opportunities for gait and gait-related research by creating more naturalistic yet controlled environments through immersive virtual reality. Investigating the neuronal aspects of gait requires parallel recording of brain activity, such as through mobile electroencephalography (EEG) and/or mobile functional near-infrared spectroscopy (fNIRS), which must be synchronized with the kinetic and /or kinematic data recorded while walking. This proof-of-concept study outlines the required setup by use of the lab streaming layer (LSL) ecosystem for real-time, simultaneous data collection of two independently operating multi-channel EEG and fNIRS measurement devices and gait kinetics. In this context, a customized approach using a photodiode to synchronize the systems is described. This study demonstrates the achievable temporal accuracy of synchronous data acquisition of neurophysiological and kinematic and kinetic data collection in the GRAIL. By using event-related cerebral hemodynamic activity and visually evoked potentials during a start-to-go task and a checkerboard test, we were able to confirm that our measurement system can replicate known physiological phenomena with latencies in the millisecond range and relate neurophysiological and kinetic data to each other with sufficient accuracy.
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Affiliation(s)
| | | | | | | | - Dieter F. Kutz
- Department of Neuromotor Behavior and Exercise, University of Münster, 48149 Münster, Germany; (S.A.M.); (T.G.); (R.S.); (C.V.-R.)
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Bonassi G, Zhao M, Samogin J, Mantini D, Marchese R, Contrino L, Tognetti P, Putzolu M, Botta A, Pelosin E, Avanzino L. Brain Networks Modulation during Simple and Complex Gait: A "Mobile Brain/Body Imaging" Study. SENSORS (BASEL, SWITZERLAND) 2024; 24:2875. [PMID: 38732980 PMCID: PMC11086305 DOI: 10.3390/s24092875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 04/24/2024] [Accepted: 04/29/2024] [Indexed: 05/13/2024]
Abstract
Walking encompasses a complex interplay of neuromuscular coordination and cognitive processes. Disruptions in gait can impact personal independence and quality of life, especially among the elderly and neurodegenerative patients. While traditional biomechanical analyses and neuroimaging techniques have contributed to understanding gait control, they often lack the temporal resolution needed for rapid neural dynamics. This study employs a mobile brain/body imaging (MoBI) platform with high-density electroencephalography (hd-EEG) to explore event-related desynchronization and synchronization (ERD/ERS) during overground walking. Simultaneous to hdEEG, we recorded gait spatiotemporal parameters. Participants were asked to walk under usual walking and dual-task walking conditions. For data analysis, we extracted ERD/ERS in α, β, and γ bands from 17 selected regions of interest encompassing not only the sensorimotor cerebral network but also the cognitive and affective networks. A correlation analysis was performed between gait parameters and ERD/ERS intensities in different networks in the different phases of gait. Results showed that ERD/ERS modulations across gait phases in the α and β bands extended beyond the sensorimotor network, over the cognitive and limbic networks, and were more prominent in all networks during dual tasks with respect to usual walking. Correlation analyses showed that a stronger α ERS in the initial double-support phases correlates with shorter step length, emphasizing the role of attention in motor control. Additionally, β ERD/ERS in affective and cognitive networks during dual-task walking correlated with dual-task gait performance, suggesting compensatory mechanisms in complex tasks. This study advances our understanding of neural dynamics during overground walking, emphasizing the multidimensional nature of gait control involving cognitive and affective networks.
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Affiliation(s)
- Gaia Bonassi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, Italy;
| | - Mingqi Zhao
- Research Center for Motor Control and Neuroplasticity, KU Leuven, 3001 Leuven, Belgium; (M.Z.); (J.S.); (D.M.)
- Gansu Provincial Key Laboratory of Wearable Computing, School of Information Science and Engineering, Lanzhou University, Lanzhou 730000, China
| | - Jessica Samogin
- Research Center for Motor Control and Neuroplasticity, KU Leuven, 3001 Leuven, Belgium; (M.Z.); (J.S.); (D.M.)
| | - Dante Mantini
- Research Center for Motor Control and Neuroplasticity, KU Leuven, 3001 Leuven, Belgium; (M.Z.); (J.S.); (D.M.)
| | - Roberta Marchese
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (R.M.); (A.B.); (L.A.)
| | - Luciano Contrino
- S.C. Medicina Fisica e Riabilitazione Ospedaliera, Azienda Sanitaria Locale Chiavarese, 16043 Chiavari, Italy; (L.C.); (P.T.)
| | - Paola Tognetti
- S.C. Medicina Fisica e Riabilitazione Ospedaliera, Azienda Sanitaria Locale Chiavarese, 16043 Chiavari, Italy; (L.C.); (P.T.)
| | - Martina Putzolu
- Department of Experimental Medicine, Section of Human Physiology, University of Genoa, Viale Benedetto XV 3, 16132 Genoa, Italy;
| | - Alessandro Botta
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (R.M.); (A.B.); (L.A.)
| | - Elisa Pelosin
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, Italy;
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (R.M.); (A.B.); (L.A.)
| | - Laura Avanzino
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (R.M.); (A.B.); (L.A.)
- Department of Experimental Medicine, Section of Human Physiology, University of Genoa, Viale Benedetto XV 3, 16132 Genoa, Italy;
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Parry R, Buttelli O, Sellam N, Riff J, Vidailhet M, Welter ML, Lalo E. 'Le regard des autres': the experience of walking in social environments as a person with Parkinson's disease. Psychol Health 2024; 39:171-194. [PMID: 35255746 DOI: 10.1080/08870446.2022.2047187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 02/22/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To examine the experience of people with Parkinson's disease when walking in different social situations, and improve understanding of how this affects participation in meaningful activity. METHODS A convenience sample of fourteen people with Parkinson's disease and a history of gait dysfunction was recruited. In-depth interviews and direct observations were conducted in the participants' home environments. Specific examples from community mobility were reviewed using first person interviewing techniques with the support of video footage. Interview transcripts were analyzed using an interpretive phenomenological approach to derive key themes. RESULTS The feeling of 'being looked at' (le regard des autres) was the central theme in participant discourse. This sentiment was inextricably linked to the given norms of the social setting, and the relationships between participants and others within that environment. Participants sought to manage how they were perceived by others through modification of posture/gait patterns; disclosure of their neurological disease; and avoidance/withdrawal from social situations. CONCLUSION Further to the functional aspects of mobility, gait is important for maintaining self-image in people with Parkinson's disease. Affective gaze interactions have significant consequences upon participation restriction. These findings underscore the interest of activities which strengthen self-image and validate movement diversity in PD rehabilitation.
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Affiliation(s)
- Ross Parry
- LINP2 - Laboratoire Interdisciplinaire en Neurosciences, Physiologie et Psychologie: Activité Physique, Santé et Apprentissages, UPL, Université Paris Nanterre, Nanterre, France
| | - Olivier Buttelli
- Sciences et Techniques des Activités Physiques et Sportive, Université d'Orléans, Orléans, France
| | - Narjis Sellam
- Paris Brain Institute, ICM, Inserm U 1127, CNRS UMR 7225, Sorbonne Université, Paris, France
| | - Jacques Riff
- Sciences et Techniques des Activités Physiques et Sportive, Université d'Orléans, Orléans, France
| | - Marie Vidailhet
- Paris Brain Institute, ICM, Inserm U 1127, CNRS UMR 7225, Sorbonne Université, Paris, France
- Department of Neurology, AP-HP, Salpêtrière Hospital, Paris, France
| | - Marie-Laure Welter
- Paris Brain Institute, ICM, Inserm U 1127, CNRS UMR 7225, Sorbonne Université, Paris, France
- Department of Neurophysiology, Rouen University Hospital and University of Rouen, Rouen, France
| | - Elodie Lalo
- Sciences et Techniques des Activités Physiques et Sportive, Université d'Orléans, Orléans, France
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Mustile M, Kourtis D, Edwards MG, Ladouce S, Volpe D, Pilleri M, Pelosin E, Learmonth G, Donaldson DI, Ietswaart M. Characterizing neurocognitive impairments in Parkinson's disease with mobile EEG when walking and stepping over obstacles. Brain Commun 2023; 5:fcad326. [PMID: 38107501 PMCID: PMC10724048 DOI: 10.1093/braincomms/fcad326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 10/03/2023] [Accepted: 11/27/2023] [Indexed: 12/19/2023] Open
Abstract
The neural correlates that help us understand the challenges that Parkinson's patients face when negotiating their environment remain under-researched. This deficit in knowledge reflects the methodological constraints of traditional neuroimaging techniques, which include the need to remain still. As a result, much of our understanding of motor disorders is still based on animal models. Daily life challenges such as tripping and falling over obstacles represent one of the main causes of hospitalization for individuals with Parkinson's disease. Here, we report the neural correlates of naturalistic ambulatory obstacle avoidance in Parkinson's disease patients using mobile EEG. We examined 14 medicated patients with Parkinson's disease and 17 neurotypical control participants. Brain activity was recorded while participants walked freely, and while they walked and adjusted their gait to step over expected obstacles (preset adjustment) or unexpected obstacles (online adjustment) displayed on the floor. EEG analysis revealed attenuated cortical activity in Parkinson's patients compared to neurotypical participants in theta (4-7 Hz) and beta (13-35 Hz) frequency bands. The theta power increase when planning an online adjustment to step over unexpected obstacles was reduced in Parkinson's patients compared to neurotypical participants, indicating impaired proactive cognitive control of walking that updates the online action plan when unexpected changes occur in the environment. Impaired action planning processes were further evident in Parkinson's disease patients' diminished beta power suppression when preparing motor adaptation to step over obstacles, regardless of the expectation manipulation, compared to when walking freely. In addition, deficits in reactive control mechanisms in Parkinson's disease compared to neurotypical participants were evident from an attenuated beta rebound signal after crossing an obstacle. Reduced modulation in the theta frequency band in the resetting phase across conditions also suggests a deficit in the evaluation of action outcomes in Parkinson's disease. Taken together, the neural markers of cognitive control of walking observed in Parkinson's disease reveal a pervasive deficit of motor-cognitive control, involving impairments in the proactive and reactive strategies used to avoid obstacles while walking. As such, this study identified neural markers of the motor deficits in Parkinson's disease and revealed patients' difficulties in adapting movements both before and after avoiding obstacles in their path.
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Affiliation(s)
- Magda Mustile
- Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, FK9 4LA, UK
- The Psychological Sciences Research Institute, Université catholique de Louvain, 1348 Louvain-la-Neuve, Belgium
| | - Dimitrios Kourtis
- Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, FK9 4LA, UK
| | - Martin G Edwards
- The Psychological Sciences Research Institute, Université catholique de Louvain, 1348 Louvain-la-Neuve, Belgium
| | - Simon Ladouce
- Department of Brain and Cognition, Leuven Brain Institute, KU Leuven, 3000 Leuven, Belgium
| | - Daniele Volpe
- Fresco Parkinson Center, Villa Margherita, S. Stefano Riabilitazione, 36100 Vicenza, Italy
| | - Manuela Pilleri
- Fresco Parkinson Center, Villa Margherita, S. Stefano Riabilitazione, 36100 Vicenza, Italy
| | - Elisa Pelosin
- Ospedale Policlinico San Martino, IRCCS, 16132 Genova, Italy
| | - Gemma Learmonth
- Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, FK9 4LA, UK
- School of Psychology & Neuroscience, University of Glasgow, Glasgow, G12 8QQ, UK
| | - David I Donaldson
- School of Psychology and Neuroscience, University of St Andrews, St. Andrews, KY16 9AJ, UK
| | - Magdalena Ietswaart
- Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, FK9 4LA, UK
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Blanchet M, Prince F. Mediolateral Postural Control Mechanisms and Proprioception Improve With Kicking Sports Training During Adolescence. Pediatr Exerc Sci 2023:1-9. [PMID: 37391194 DOI: 10.1123/pes.2020-0204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 11/29/2021] [Accepted: 01/18/2022] [Indexed: 07/02/2023]
Abstract
Sensorimotor stimulation during the sensitive period is crucial for proper brain development. Kicking sports (KS) training stimulates these sensorimotor functions. The purpose of this study was to investigate if incorporating specific sensorimotor stimulation in mediolateral axis and proprioceptive inputs during KS training will improve the specific sensorimotor performance in adolescents. We assessed stability limits in 13 KS practitioners and 20 control participants. Starting from an upright position, subjects were asked to lean as far as possible (forward, backward, rightward, and leftward). Three sensory conditions were tested: (1) eyes open, (2) eyes closed, and (3) eyes closed while standing on a foam mat. We analyzed the maximal center of pressure excursion and the root means square of the center of pressure displacements. Results showed that KS group had smaller root means square and larger maximal center of pressure excursions than those of control participants in mediolateral axis in all sensory conditions. Furthermore, the results also revealed a significant smaller root means square excursion in KS group under foam mat condition compared to control group ML axis. This study provides evidence that KS training improved the lateral balance control and proprioceptive integration.
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Affiliation(s)
- Mariève Blanchet
- Département des sciences de l'activité physique, Université du Québec à Montréal, Montréal, QC,Canada
| | - François Prince
- Département de chirurgie, Faculté de médecine, Université de Montréal, Montréal, QC,Canada
- Institut national du sport du Québec, Montréal, QC,Canada
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Pourahmad R, Saleki K, Esmaili M, Abdollahi A, Alijanizadeh P, Gholinejad MZ, Banazadeh M, Ahmadi M. Deep brain stimulation (DBS) as a therapeutic approach in gait disorders: What does it bring to the table? IBRO Neurosci Rep 2023; 14:507-513. [PMID: 37304345 PMCID: PMC10248795 DOI: 10.1016/j.ibneur.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 05/17/2023] [Accepted: 05/18/2023] [Indexed: 06/13/2023] Open
Abstract
Gait deficits are found in various degenerative central nervous system conditions, and are particularly a hallmark of Parkinson's disease (PD). While there is no cure for such neurodegenerative disorders, Levodopa is considered as the standard medication in PD patients. Often times, the therapy of severe PD consists of deep brain stimulation (DBS) of the subthalamic nucleus. Earlier research exploring the effect of gait have reported contradictory results or insufficient efficacy. A change in gait includes various parameters, such as step length, cadence, Double-stance phase duration which may be positively affected by DBS. DBS could also be effective in correcting the levodopa-induced postural sway abnormalities. Moreover, during normal walking, interaction among the subthalamic nucleus and cortex -essential regions which exert a role in locomotion- are coupled. However, during the freezing of gait, the activity is desynchronized. The mechanisms underlying DBS-induced neurobehavioral improvements in such scenarios requires further study. The present review discusses DBS in the context of gait, the benefits associated with DBS compared to standard pharmacotherapy options, and provides insights into future research.
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Affiliation(s)
- Ramtin Pourahmad
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Kiarash Saleki
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
- Department of e-Learning, Virtual School of Medical Education and Management, Shahid Beheshti University of Medical Sciences(SBMU), Tehran, Iran
- USERN Office, Babol University of Medical Sciences, Babol, Iran
| | | | - Arian Abdollahi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Parsa Alijanizadeh
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
- USERN Office, Babol University of Medical Sciences, Babol, Iran
| | | | - Mohammad Banazadeh
- Pharmaceutical Sciences and Cosmetic Products Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Mona Ahmadi
- Department of Neurology, School of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
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Walusinski O. From hysteria to gait dementia: History of the concept of astasia-abasia. Rev Neurol (Paris) 2023:S0035-3787(23)00917-7. [PMID: 37030986 DOI: 10.1016/j.neurol.2022.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 12/04/2022] [Accepted: 12/22/2022] [Indexed: 04/10/2023]
Abstract
Paul Blocq (1860-1896) and his teacher Jean-Martin Charcot (1825-1893) introduced the expression "astasia-abasia" into medical terminology in 1888 to designate a pathology they believed to be caused by hysteria. This condition makes it impossible to remain erect and to walk, whereas the ability to move the legs while lying down remains normal. At the turn of the 20th century, and now almost exclusively, this motor disturbance is recognised as a syndrome with multiple possible organic causes, and now described as "higher-level gait disorder". After briefly mentioning earlier descriptions by other authors, I will review Charcot's Tuesday lessons in 1889 that covered astasia-abasia and elucidated the beginnings of the breakdown into organic aetiologies: medial-frontal and corpus callosum tumors, damage to the cerebellar vermis, lacunar state as described by Pierre Marie (1853-1940), Parkinson's disease, and Parkinson-plus syndrome. The long history of astasia-abasia reveals a cluster of neurologists, often emerging from oblivion herein and all of whom, through the precision of their clinical examinations and their pathophysiological findings, helped advance the understanding of the mechanisms by which human beings are the only erect, constantly bipedal mammals, whether immobile or walking.
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Affiliation(s)
- O Walusinski
- Lauréat de l'Académie nationale de Médecine, 20, rue de Chartres, 28160 Brou, France.
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9
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Belgrado E, Tereshko Y, Tuniz F, Lettieri C, Bagatto D, Fabbro S, Piccolo D, Gigli GL, Skrap M, Valente M. MDS-UDPRS-III in the diagnosis of idiopathic Normal Pressure Hydrocephalus and identification of candidates for Ventriculo-Peritoneal Shunting surgery. Results from a retrospective large cohort of patients. J Neurol Sci 2023; 445:120536. [PMID: 36587562 DOI: 10.1016/j.jns.2022.120536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 12/21/2022] [Accepted: 12/26/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To evaluate the entity of extrapyramidal signs, characterize them and evaluate the dynamics of change by the mean of MDS-UPDRS-III in iNPH patients after the TT to determine if this tool may help the diagnosis of iNPH and the identification of candidates for Ventriculo-Peritoneal Shunting. MATERIALS AND METHODS We retrospectively collected data from 120 patients with the initial diagnosis of possible iNPH; they underwent neurological examination by the means of MDS-UPDRS-III and other scales before and after Tap Test (TT). They were then classified as defined iNPH (57), probable iNPH (35), and NOT-iNPH (28) based on the clinical response after the Tap Test and VPS. RESULTS After the Tap Test, defined and probable iNPH groups improved by 3.35 (2.57-4.12, p < 0.001) and 3.43 (2.43-4.4, p < 0.001) points on MDS-UPDRS-III respectively; NOT-iNPH did not improve significantly on MDS-UPDRS-III and on any other variable studies. Defined iNPH also shifted significantly from asymmetric prevalence of symptoms to a more symmetric form (from 70% before to 57% after). CONCLUSION extrapyramidal signs improved significantly after the Tap Test in definite and probable iNPH patients. MDS-UPDRS-III may be a useful complementary tool in the diagnosis of iNPH and identification of candidates for Ventriculo-Peritoneal Shunting.
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Affiliation(s)
- Enrico Belgrado
- Department of Neurology, Udine University Hospital, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy
| | - Yan Tereshko
- Department of Clinical Neurology, Udine University Hospital, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy.
| | - Francesco Tuniz
- Department of Neurosurgery, University of Udine, Via Colugna 50, 33100 Udine, Italy
| | - Christian Lettieri
- Department of Neurology, Udine University Hospital, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy
| | - Daniele Bagatto
- Department of Neuroradiology, University of Udine, Via Colugna 50, 33100 Udine, Italy
| | - Sara Fabbro
- Department of Neurosurgery, University of Udine, Via Colugna 50, 33100 Udine, Italy
| | - Daniele Piccolo
- Department of Neurosurgery, University of Udine, Via Colugna 50, 33100 Udine, Italy
| | - Gian Luigi Gigli
- Department of Clinical Neurology, Udine University Hospital, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy
| | - Miran Skrap
- Department of Neurosurgery, University of Udine, Via Colugna 50, 33100 Udine, Italy
| | - Mariarosaria Valente
- Department of Clinical Neurology, Udine University Hospital, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy
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10
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Wang Y, Yu N, Lu J, Zhang X, Wang J, Shu Z, Cheng Y, Zhu Z, Yu Y, Liu P, Han J, Wu J. Increased Effective Connectivity of the Left Parietal Lobe During Walking Tasks in Parkinson's Disease. JOURNAL OF PARKINSON'S DISEASE 2023; 13:165-178. [PMID: 36872789 PMCID: PMC10041419 DOI: 10.3233/jpd-223564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
BACKGROUND In Parkinson's disease (PD), walking may depend on the activation of the cerebral cortex. Understanding the patterns of interaction between cortical regions during walking tasks is of great importance. OBJECTIVE This study investigated differences in the effective connectivity (EC) of the cerebral cortex during walking tasks in individuals with PD and healthy controls. METHODS We evaluated 30 individuals with PD (62.4±7.2 years) and 22 age-matched healthy controls (61.0±6.4 years). A mobile functional near-infrared spectroscopy (fNIRS) was used to record cerebral oxygenation signals in the left prefrontal cortex (LPFC), right prefrontal cortex (RPFC), left parietal lobe (LPL), and right parietal lobe (RPL) and analyze the EC of the cerebral cortex. A wireless movement monitor was used to measure the gait parameters. RESULTS Individuals with PD demonstrated a primary coupling direction from LPL to LPFC during walking tasks, whereas healthy controls did not demonstrate any main coupling direction. Compared with healthy controls, individuals with PD showed statistically significantly increased EC coupling strength from LPL to LPFC, from LPL to RPFC, and from LPL to RPL. Individuals with PD showed decreased gait speed and stride length and increased variability in speed and stride length. The EC coupling strength from LPL to RPFC negatively correlated with speed and positively correlated with speed variability in individuals with PD. CONCLUSION In individuals with PD, the left prefrontal cortex may be regulated by the left parietal lobe during walking. This may be the result of functional compensation in the left parietal lobe.
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Affiliation(s)
- Yue Wang
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
| | - Ningbo Yu
- College of Artificial Intelligence, Nankai University, Tianjin, China
- Tianjin Key Laboratory of Intelligent Robotics, Nankai University, Tianjin, China
| | - Jiewei Lu
- College of Artificial Intelligence, Nankai University, Tianjin, China
- Tianjin Key Laboratory of Intelligent Robotics, Nankai University, Tianjin, China
| | - Xinyuan Zhang
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
| | - Jin Wang
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Zhilin Shu
- College of Artificial Intelligence, Nankai University, Tianjin, China
- Tianjin Key Laboratory of Intelligent Robotics, Nankai University, Tianjin, China
| | - Yuanyuan Cheng
- Department of Rehabilitation Medicine, Tianjin Huanhu Hospital, Tianjin, China
| | - Zhizhong Zhu
- Department of Rehabilitation Medicine, Tianjin Huanhu Hospital, Tianjin, China
| | - Yang Yu
- Department of Rehabilitation Medicine, Tianjin Huanhu Hospital, Tianjin, China
| | - Peipei Liu
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Jianda Han
- College of Artificial Intelligence, Nankai University, Tianjin, China
- Tianjin Key Laboratory of Intelligent Robotics, Nankai University, Tianjin, China
| | - Jialing Wu
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
- Department of Rehabilitation Medicine, Tianjin Huanhu Hospital, Tianjin, China
- Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, Tianjin Neurosurgical Institute, Tianjin, China
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Gialanella B, Gaiani M, Comini L, Olivares A, Di Pietro D, Vanoglio F, Cenicola A, Vezzadini G. Walking function determinants in parkinson patients undergoing rehabilitation. NeuroRehabilitation 2022; 51:481-488. [DOI: 10.3233/nre-220103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: To date little is known about factors affecting walking rehabilitation in Parkinson’s disease (PD) patients. OBJECTIVE: This prospective observational cohort study evaluated the walking distance covered in 6 minutes (6 MWD) before and after conventional rehabilitation and verified which among PD motor disorders was the most important determinant of walking distance in PD patients undergoing rehabilitation. METHODS: Data were collected from 55 PD patients, performing a conventional outpatient motor rehabilitation program. The 6MWD at the end of rehabilitation and gain in 6MWD were the outcome measures. The Unified Parkinson’s Disease Rating Scale, Hoehn and Yahr scale, Nine Hole Peg Test, Grip and Pinch test, ROM wrist motility, and Berg Balance Scale (BBS) were used to assess PD patients at admission and were considered as dependent variables. Backward multiple regression analyses identified the determinants of 6MWD outcomes. RESULTS: The 6MWD was 246.58±115 meters at admission and 286.90±116 at the end of rehabilitation. At end of rehabilitation, the 6MWD was 42.32±47 meters greater than admission (p < 0.001), corresponding to an increase of +17.16% . At the end of rehabilitation, the 6MWD was significantly longer in PD patients with stages 1–3 of the Hoehn and Yahr scale. Berg Balance Scale (β= 0.47, p < 0.001) and right Grip and Pinch at admission (β= 0.36, p = 0.001) were the only determinants of final 6MWD. The R2 value of the model was 0.47 (R2 adjusted 0.45). No variable was a determinant of gain in 6MWD. CONCLUSIONS: The study indicates that balance and generalized muscle strength are important determinants of walking rehabilitation in PD patients, in whom it is essential to maintain high levels of balance and muscle strength for a time as long as possible. These findings suggest planning more intensive rehabilitation treatments in PD patients with low levels of balance and muscle strength.
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Affiliation(s)
- Bernardo Gialanella
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation of the Institute of Lumezzane, Brescia, Italy
| | - Marta Gaiani
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation of the Institute of Lumezzane, Brescia, Italy
| | - Laura Comini
- Istituti Clinici Scientifici Maugeri IRCCS, Scientific Direction of the Institute of Lumezzane, Brescia, Italy
| | - Adriana Olivares
- Istituti Clinici Scientifici Maugeri IRCCS, Scientific Direction of the Institute of Lumezzane, Brescia, Italy
| | - Davide Di Pietro
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation of the Institute of Lumezzane, Brescia, Italy
| | - Fabio Vanoglio
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation of the Institute of Lumezzane, Brescia, Italy
| | - Alice Cenicola
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation of the Institute of Castel Goffredo Mantova, Italy
| | - Giuliana Vezzadini
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation of the Institute of Castel Goffredo Mantova, Italy
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12
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Li K, Zhu Y, Ning P, Bao J, Liu B, Yang H, Yin W, Xu Y, Ren H, Yang X. Development and validation of a nomogram for freezing of gait in patients with Parkinson's Disease. Acta Neurol Scand 2022; 145:658-668. [PMID: 35043400 DOI: 10.1111/ane.13583] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/13/2021] [Accepted: 01/06/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Freezing of gait (FOG) is a common and complex disabling episodic gait disturbance in patients with Parkinson's disease (PD). Currently, the treatment of FOG remains a challenge for clinicians. The aim of our study was to develop a nomogram for FOG risk based on data collected from Chinese patients with PD. MATERIALS & METHODS A total of 379 PD patients (197 with FOG) from Kunming Medical University were recruited as a training cohort. Additionally, 339 PD patients (166 with FOG) were recruited from West China Hospital of Sichuan University, to serve as the validation cohort. The least absolute shrinkage and selection operator regression model was used to select clinical and demographic characteristics as well as blood markers, which were incorporated into a predictive model using multivariate logistic regression to predict the risk of developing FOG. The model was validated using the validation dataset, and model performance was evaluated using the C-index, calibration plot, and decision curve analyses. RESULTS The final predictive model included the REM Sleep Behavior Disorder Screening Questionnaire (RBDSQ) score, Parkinson's Disease Questionnaire (PDQ39), H-Y stage, and visuospatial function. The model showed good calibration and good discrimination, with a C-index value of 0.772 against the training cohort and 0.766 against the validation cohort. Decision curve analysis demonstrated the clinical utility of the nomogram. CONCLUSION A nomogram incorporating RBDSQ, PDQ39, H-Y stage, and visuospatial function may reliably predict the risk of FOG in PD patients.
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Affiliation(s)
- Kelu Li
- Department of Geriatric Neurology First Affiliated Hospital of Kunming Medical University Kunming China
| | - Yongyun Zhu
- Department of Geriatric Neurology First Affiliated Hospital of Kunming Medical University Kunming China
| | - Pingping Ning
- Department of Neurology West China Hospital Sichuan University Chengdu China
| | - Jianjian Bao
- Department of Neurology Qujing City First People's Hospital Qujing China
| | - Bin Liu
- Department of Geriatric Neurology First Affiliated Hospital of Kunming Medical University Kunming China
- Yunnan Province Clinical Research Center for Gerontology Kunming China
| | - Hongju Yang
- Department of Geriatric Neurology First Affiliated Hospital of Kunming Medical University Kunming China
- Yunnan Province Clinical Research Center for Gerontology Kunming China
| | - Weifang Yin
- Department of Geriatric Neurology First Affiliated Hospital of Kunming Medical University Kunming China
| | - Yanming Xu
- Department of Neurology West China Hospital Sichuan University Chengdu China
| | - Hui Ren
- Department of Geriatric Neurology First Affiliated Hospital of Kunming Medical University Kunming China
- Yunnan Province Clinical Research Center for Gerontology Kunming China
| | - Xinglong Yang
- Department of Geriatric Neurology First Affiliated Hospital of Kunming Medical University Kunming China
- Yunnan Province Clinical Research Center for Gerontology Kunming China
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Abidi M, Pradat PF, Termoz N, Couillandre A, Bede P, de Marco G. Motor imagery in amyotrophic lateral Sclerosis: An fMRI study of postural control. Neuroimage Clin 2022; 35:103051. [PMID: 35598461 PMCID: PMC9127212 DOI: 10.1016/j.nicl.2022.103051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 04/02/2022] [Accepted: 05/15/2022] [Indexed: 11/13/2022]
Abstract
ALS is associated with postural control impairment. DCM and PEB frameworks help to characterize connectivity patterns during gait. Clinical manifestations of ALS are underpinned by selective network dysfunction. Altered BG-SMA and SMA-PPC connectivity are observed during imagined gait in ALS. Enhanced BG-cerebellar connectivity may represent functional adaptation.
Background The functional reorganization of brain networks sustaining gait is poorly characterized in amyotrophic lateral sclerosis (ALS) despite ample evidence of progressive disconnection between brain regions. The main objective of this fMRI study is to assess gait imagery-specific networks in ALS patients using dynamic causal modeling (DCM) complemented by parametric empirical Bayes (PEB) framework. Method Seventeen lower motor neuron predominant (LMNp) ALS patients, fourteen upper motor neuron predominant (UMNp) ALS patients and fourteen healthy controls participated in this study. Each subject performed a dual motor imagery task: normal and precision gait. The Movement Imagery Questionnaire (MIQ-rs) and imagery time (IT) were used to evaluate gait imagery in each participant. In a neurobiological computational model, the circuits involved in imagined gait and postural control were investigated by modelling the relationship between normal/precision gait and connection strengths. Results Behavioral results showed significant increase in IT in UMNp patients compared to healthy controls (Pcorrected < 0.05) and LMNp (Pcorrected < 0.05). During precision gait, healthy controls activate the model's circuits involved in the imagined gait and postural control. In UMNp, decreased connectivity (inhibition) from basal ganglia (BG) to supplementary motor area (SMA) and from SMA to posterior parietal cortex (PPC) is observed. Contrary to healthy controls, DCM detects no cerebellar-PPC connectivity in neither UMNp nor LMNp ALS. During precision gait, bilateral connectivity (excitability) between SMA and BG is observed in the LMNp group contrary to UMNp and healthy controls. Conclusions Our findings demonstrate the utility of implementing both DCM and PEB to characterize connectivity patterns in specific patient phenotypes. Our approach enables the identification of specific circuits involved in postural deficits, and our findings suggest a putative excitatory–inhibitory imbalance. More broadly, our data demonstrate how clinical manifestations are underpinned by network-specific disconnection phenomena in ALS.
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Affiliation(s)
- Malek Abidi
- LINP2 Laboratory, UPL, Paris Nanterre University, France; COMUE Paris Lumières University, France
| | - Pierre-Francois Pradat
- Department of Neurology, Pitié-Salpêtrière University Hospital, Paris, France; Biomedical Imaging Laboratory, Sorbonne University, CNRS, INSERM, Paris, France; Biomedical Sciences Research Institute, Northern Ireland Centre for Stratified Medicine, Ulster University, Londonderry, UK
| | - Nicolas Termoz
- LINP2 Laboratory, UPL, Paris Nanterre University, France; COMUE Paris Lumières University, France
| | - Annabelle Couillandre
- LINP2 Laboratory, UPL, Paris Nanterre University, France; Université Paris-Saclay,CIAMS, Orsay, France
| | - Peter Bede
- Department of Neurology, Pitié-Salpêtrière University Hospital, Paris, France; Biomedical Imaging Laboratory, Sorbonne University, CNRS, INSERM, Paris, France; Computational Neuroimaging Group, Trinity College Dublin, Ireland
| | - Giovanni de Marco
- LINP2 Laboratory, UPL, Paris Nanterre University, France; COMUE Paris Lumières University, France.
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Relationship of the Nigrostriatal Tract with the Motor Function and the Corticospinal Tract in Chronic Hemiparetic Stroke Patients: A Diffusion Tensor Imaging Study. Healthcare (Basel) 2022; 10:healthcare10040731. [PMID: 35455908 PMCID: PMC9028700 DOI: 10.3390/healthcare10040731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/06/2022] [Accepted: 04/12/2022] [Indexed: 01/25/2023] Open
Abstract
This study investigated the relationship of the nigrostriatal tract (NST) with motor function and the corticospinal tract (CST) using diffusion tensor tractography in chronic hemiparetic stroke patients. Forty-three consecutive patients with putaminal hemorrhage in the chronic stage were recruited. The Motricity Index was used to evaluate the motor function of affected hemiparetic extremities. The fractional anisotropy and the tract volume of ipsilesional NST and ipsilesional CST were acquired. The tract volume (Rho = 0.824) of ipsilesional NST and fractional anisotropy (r = 0.682) and the tract volume (Rho = 0.886) of ipsilesional CST showed a strong positive correlation with the Motricity Index score. The fractional anisotropy of ipsilesional NST showed moderate positive correlations with the fractional anisotropy (r = 0.449) and tract volume (Rho = 0.353) of ipsilesional CST. The tract volume of ipsilesional NST showed strong positive correlations with the fractional anisotropy (Rho = 0.716) and the tract volume (Rho = 0.799) of ipsilesional CST. The regression model showed that the tract volumes of ipsilesional NST and ipsilesional CST were positively associated with the Motricity Index score (Adjusted R2 = 0.763, F = 45.998). Mediation analysis showed that the tract volume of ipsilesional CST partially mediated the effects of the tract volume of ipsilesional NST on the Motricity Index score (z = 3.34). A close relationship was found between ipsilesional NST and the motor function of affected extremities in chronic hemiparetic patients with putaminal hemorrhage. Moreover, ipsilesional NST influenced the motor function of affected extremities indirectly through ipsilesional CST.
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15
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Wagner JR, Schaper M, Hamel W, Westphal M, Gerloff C, Engel AK, Moll CKE, Gulberti A, Pötter-Nerger M. Combined Subthalamic and Nigral Stimulation Modulates Temporal Gait Coordination and Cortical Gait-Network Activity in Parkinson's Disease. Front Hum Neurosci 2022; 16:812954. [PMID: 35295883 PMCID: PMC8919031 DOI: 10.3389/fnhum.2022.812954] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 01/27/2022] [Indexed: 01/10/2023] Open
Abstract
Background Freezing of gait (FoG) is a disabling burden for Parkinson's disease (PD) patients with poor response to conventional therapies. Combined deep brain stimulation of the subthalamic nucleus and substantia nigra (STN+SN DBS) moved into focus as a potential therapeutic option to treat the parkinsonian gait disorder and refractory FoG. The mechanisms of action of DBS within the cortical-subcortical-basal ganglia network on gait, particularly at the cortical level, remain unclear. Methods Twelve patients with idiopathic PD and chronically-implanted DBS electrodes were assessed on their regular dopaminergic medication in a standardized stepping in place paradigm. Patients executed the task with DBS switched off (STIM OFF), conventional STN DBS and combined STN+SN DBS and were compared to healthy matched controls. Simultaneous high-density EEG and kinematic measurements were recorded during resting-state, effective stepping, and freezing episodes. Results Clinically, STN+SN DBS was superior to conventional STN DBS in improving temporal stepping variability of the more affected leg. During resting-state and effective stepping, the cortical activity of PD patients in STIM OFF was characterized by excessive over-synchronization in the theta (4-8 Hz), alpha (9-13 Hz), and high-beta (21-30 Hz) band compared to healthy controls. Both active DBS settings similarly decreased resting-state alpha power and reduced pathologically enhanced high-beta activity during resting-state and effective stepping compared to STIM OFF. Freezing episodes during STN DBS and STN+SN DBS showed spectrally and spatially distinct cortical activity patterns when compared to effective stepping. During STN DBS, FoG was associated with an increase in cortical alpha and low-beta activity over central cortical areas, while with STN+SN DBS, an increase in high-beta was prominent over more frontal areas. Conclusions STN+SN DBS improved temporal aspects of parkinsonian gait impairment compared to conventional STN DBS and differentially affected cortical oscillatory patterns during regular locomotion and freezing suggesting a potential modulatory effect on dysfunctional cortical-subcortical communication in PD.
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Affiliation(s)
- Jonas R. Wagner
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Miriam Schaper
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Wolfgang Hamel
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Manfred Westphal
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andreas K. Engel
- Department of Neurophysiology and Pathophysiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian K. E. Moll
- Department of Neurophysiology and Pathophysiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alessandro Gulberti
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Neurophysiology and Pathophysiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Monika Pötter-Nerger
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Costa TM, Simieli L, Bersotti FM, Mochizuki L, Barbieri FA, Coelho DB. Gait and posture are correlated domains in Parkinson's disease. Neurosci Lett 2022; 775:136537. [PMID: 35192916 DOI: 10.1016/j.neulet.2022.136537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 02/15/2022] [Accepted: 02/15/2022] [Indexed: 10/19/2022]
Abstract
Establishing a relationship between gait and posture in patients with Parkinson's disease (PD) is essential for PD treatment and rehabilitation. While previous studies have indicated that gait and posture are independent domains in PD, shared neuromechanisms related to gait and posture control and previous studies investigating the relationship between gait and posture parameters in stroke survivors and neurologically healthy older adults have shown a correlated domain. Thus, this study analyzed the relationship of gait and posture domains, primarily through gait temporal sub-phases (i.e., double support and stance phases) and step width. We analyzed the spatial-temporal gait parameters at the self-selected velocity and center of pressure (CoP) during quiet standing of 22 idiopathic PD participants under and without dopaminergic medication conditions. The association between quiet standing and gait variables was assessed through the Spearman test, controlled by age, disease duration, NFoG-Q, and levodopa dosage. In ON medication, CoP area showed a significant correlation with stance phase and total double support; and RMS ML CoP showed a significant correlation with stance phase, total double support, and step width. In OFF medication, CoP area, RMS AP CoP, RMS ML CoP, and ML CoP velocity significantly correlated with stance phase and total double support. By showing the relationship between gait and posture domains in PD, our study adds novel knowledge about the shared gait-posture control, which could collaborate with new approaches during mobility treatment and assessment.
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Affiliation(s)
- Thaisy Moraes Costa
- Biomedical Engineering, Federal University of ABC, São Bernardo do Campo, SP, Brazil
| | - Lucas Simieli
- Human Movement Research Laboratory (MOVI-LAB), Department of Physical Education, Faculty of Sciences, São Paulo State University (Unesp), Bauru, SP, Brazil; Faculdade Estácio de Sá - Campus Ribeirão Preto, SP, Brazil
| | | | - Luis Mochizuki
- School of Arts, Sciences and Humanities, University of São Paulo, São Paulo, SP, Brazil
| | - Fabio Augusto Barbieri
- Human Movement Research Laboratory (MOVI-LAB), Department of Physical Education, Faculty of Sciences, São Paulo State University (Unesp), Bauru, SP, Brazil
| | - Daniel Boari Coelho
- Biomedical Engineering, Federal University of ABC, São Bernardo do Campo, SP, Brazil.
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Rösch AD, Taub E, Gschwandtner U, Fuhr P. Evaluating a Speech-Specific and a Computerized Step-Training-Specific Rhythmic Intervention in Parkinson's Disease: A Cross-Over, Multi-Arms Parallel Study. FRONTIERS IN REHABILITATION SCIENCES 2022; 2:783259. [PMID: 36188780 PMCID: PMC9397933 DOI: 10.3389/fresc.2021.783259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 12/14/2021] [Indexed: 11/27/2022]
Abstract
Background: Recent studies suggest movements of speech and gait in patients with Parkinson's Disease (PD) are impaired by a common underlying rhythmic dysfunction. If this being the case, motor deficits in speech and gait should equally benefit from rhythmic interventions regardless of whether it is a speech-specific or step-training-specific approach. Objective: In this intervention trial, we studied the effects of two rhythmic interventions on speech and gait. These rhythmic intervention programs are similar in terms of intensity and frequency (i.e., 3x per week, 45 min-long sessions for 4 weeks in total), but differ regarding therapeutic approach (rhythmic speech vs. rhythmic balance-mobility training). Methods: This study is a cross-over, parallel multi-arms, single blind intervention trial, in which PD patients treated with rhythmic speech-language therapy (rSLT; N = 16), rhythmic balance-mobility training (rBMT; N = 10), or no therapy (NT; N = 18) were compared to healthy controls (HC; N = 17; matched by age, sex, and education: p > 0.82). Velocity and cadence in speech and gait were evaluated at baseline (BL), 4 weeks (4W-T1), and 6 months (6M-T2) and correlated. Results: Parameters in speech and gait (i.e., speaking and walking velocity, as well as speech rhythm with gait cadence) were positively correlated across groups (p < 0.01). Statistical analyses involved repeated measures ANOVA across groups and time, as well as independent and one-samples t-tests for within groups analyses. Statistical analyses were amplified using Reliable Change (RC) and Reliable Change Indexes (RCI) to calculate true clinically significant changes due to the treatment on a patient individual level. Rhythmic intervention groups improved across variables and time (total Mean Difference: 3.07 [SD 1.8]; 95% CI 0.2–11.36]) compared to the NT group, whose performance declined significantly at 6 months (p < 0.01). HC outperformed rBMT and NT groups across variables and time (p < 0.001); the rSLT performed similarly to HC at 4 weeks and 6 months in speech rhythm and respiration. Conclusions: Speech and gait deficits in PD may share a common mechanism in the underlying cortical circuits. Further, rSLT was more beneficial to dysrhythmic PD patients than rBMT, likely because of the nature of the rhythmic cue.
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Affiliation(s)
- Anne Dorothée Rösch
- Department of Clinical Neurophysiology/Neurology, Hospital of the University of Basel, Basel, Switzerland
| | - Ethan Taub
- Department of Neurosurgery, Hospital of the University of Basel, Basel, Switzerland
| | - Ute Gschwandtner
- Department of Clinical Neurophysiology/Neurology, Hospital of the University of Basel, Basel, Switzerland
- *Correspondence: Ute Gschwandtner
| | - Peter Fuhr
- Department of Clinical Neurophysiology/Neurology, Hospital of the University of Basel, Basel, Switzerland
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18
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Bardakan MM, Fink GR, Zapparoli L, Bottini G, Paulesu E, Weiss PH. Imaging the neural underpinnings of freezing of gait in Parkinson’s disease. NEUROIMAGE: CLINICAL 2022; 35:103123. [PMID: 35917720 PMCID: PMC9421505 DOI: 10.1016/j.nicl.2022.103123] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/09/2022] [Accepted: 07/20/2022] [Indexed: 11/04/2022] Open
Abstract
Review of recent (after 2012) imaging studies on Parkinsonian freezing of gait. Virtual reality studies report functional decoupling of cortico-striatal circuits. Motor imagery studies reveal increased recruitment of parieto-occipital regions. fNIRS studies converge on reporting higher activity within prefrontal regions. Imaging findings support pathophysiological models of freezing of gait.
Freezing of gait (FoG) is a paroxysmal and sporadic gait impairment that severely affects PD patients’ quality of life. This review summarizes current neuroimaging investigations that characterize the neural underpinnings of FoG in PD. The review presents and discusses the latest advances across multiple methodological domains that shed light on structural correlates, connectivity changes, and activation patterns associated with the different pathophysiological models of FoG in PD. Resting-state fMRI studies mainly report cortico-striatal decoupling and disruptions in connectivity along the dorsal stream of visuomotor processing, thus supporting the ‘interference’ and the ‘perceptual dysfunction’ models of FoG. Task-based MRI studies employing virtual reality and motor imagery paradigms reveal a disruption in functional connectivity between cortical and subcortical regions and an increased recruitment of parieto-occipital regions, thus corroborating the ‘interference’ and ‘perceptual dysfunction’ models of FoG. The main findings of fNIRS studies of actual gait primarily reveal increased recruitment of frontal areas during gait, supporting the ‘executive dysfunction’ model of FoG. Finally, we discuss how identifying the neural substrates of FoG may open new avenues to develop efficient treatment strategies.
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Pol F, Salehinejad MA, Baharlouei H, Nitsche MA. The effects of transcranial direct current stimulation on gait in patients with Parkinson's disease: a systematic review. Transl Neurodegener 2021; 10:22. [PMID: 34183062 PMCID: PMC8240267 DOI: 10.1186/s40035-021-00245-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 06/07/2021] [Indexed: 12/01/2022] Open
Abstract
Background Gait problems are an important symptom in Parkinson’s disease (PD), a progressive neurodegenerative disease. Transcranial direct current stimulation (tDCS) is a neuromodulatory intervention that can modulate cortical excitability of the gait-related regions. Despite an increasing number of gait-related tDCS studies in PD, the efficacy of this technique for improving gait has not been systematically investigated yet. Here, we aimed to systematically explore the effects of tDCS on gait in PD, based on available experimental studies. Methods Using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) approach, PubMed, Web of Science, Scopus, and PEDro databases were searched for randomized clinical trials assessing the effect of tDCS on gait in patients with PD. Results Eighteen studies were included in this systematic review. Overall, tDCS targeting the motor cortex and supplementary motor area bilaterally seems to be promising for gait rehabilitation in PD. Studies of tDCS targeting the dorosolateral prefrontal cortex or cerebellum showed more heterogeneous results. More studies are needed to systematically compare the efficacy of different tDCS protocols, including protocols applying tDCS alone and/or in combination with conventional gait rehabilitation treatment in PD. Conclusions tDCS is a promising intervention approach to improving gait in PD. Anodal tDCS over the motor areas has shown a positive effect on gait, but stimulation of other areas is less promising. However, the heterogeneities of methods and results have made it difficult to draw firm conclusions. Therefore, systematic explorations of tDCS protocols are required to optimize the efficacy.
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Affiliation(s)
- Fateme Pol
- Musculoskeletal Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Ali Salehinejad
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany
| | - Hamzeh Baharlouei
- Musculoskeletal Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Michael A Nitsche
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany.,Department of Neurology, University Medical Hospital Bergmannsheil, Bochum, Germany
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Desai R, Fritz NE, Muratori L, Hausdorff JM, Busse M, Quinn L. Evaluation of gait initiation using inertial sensors in Huntington's Disease: insights into anticipatory postural adjustments and cognitive interference. Gait Posture 2021; 87:117-122. [PMID: 33906090 DOI: 10.1016/j.gaitpost.2021.04.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 03/15/2021] [Accepted: 04/14/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Understanding the contribution of anticipatory postural adjustments (APA) to walking ability in individuals with Huntington's disease (HD) may provide insight into motor planning and the functional consequences of HD-specific cortical-basal ganglia pathway dysfunctions. RESEARCH QUESTION How do inertial measurement unit (IMU)-derived APAs and first step parameters differ between individuals with HD and non-HD peers under no load and cognitive load conditions, and what is their relationship to gait speed and clinical measures? METHODS 33 individuals with manifest HD and 15 non-HD peers wore three Opal APDM IMUs during a 14-meter walk under no load and cognitive load conditions. APA acceleration amplitudes, APA durations, first step range of motion (ROM), and first step durations were compared, along with their relationship to gait speed. RESULTS Individuals with HD had greater APA acceleration amplitudes, smaller first step ROM and longer first step durations compared to non-HD peers. No differences in APA durations were present between groups in both conditions. Cognitive loading influenced first step ROM but not other APA parameters. Mediolateral APA acceleration amplitudes were a significant predictor of gait speed and were related to disease-specific measures. SIGNIFICANCE Larger acceleration amplitudes and smaller first step ROMs of greater duration, accompanied by the preservation of APA durations, reveal a discrepancy in movement scaling in HD. Additionally, the mediolateral component of the APA is likely a rate-limiting factor that drives a compensatory response in gait initiation. Further research is needed to explore the neural correlates of HD-related movement scaling.
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Affiliation(s)
- Radhika Desai
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA.
| | - Nora E Fritz
- Wayne State University, Program in Physical Therapy, Detroit, MI, USA.
| | - Lisa Muratori
- Physical Therapy Program, Stony Brook University, Stony Brook, NY, USA.
| | - Jeffrey M Hausdorff
- Center for the Study of Movement, Cognition, and Mobility, Neurological Institute,Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Department of Physical Therapy and Sagol School of Neuroscience, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Rush Alzheimer's Disease Center and Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.
| | - Monica Busse
- Centre for Trials Research, Cardiff University, Cardiff, UK.
| | - Lori Quinn
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA; Centre for Trials Research, Cardiff University, Cardiff, UK.
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21
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Orcioli-Silva D, Vitório R, Nóbrega-Sousa P, Beretta VS, Conceição NRD, Oliveira AS, Pereira MP, Gobbi LTB. Cortical Activity Underlying Gait Improvements Achieved With Dopaminergic Medication During Usual Walking and Obstacle Avoidance in Parkinson Disease. Neurorehabil Neural Repair 2021; 35:406-418. [PMID: 33754884 DOI: 10.1177/15459683211000736] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Dopaminergic medication improves gait in people with Parkinson disease (PD). However, it remains unclear if dopaminergic medication modulates cortical activity while walking. OBJECTIVE We investigated the effects of dopaminergic medication on cortical activity during unobstructed walking and obstacle avoidance in people with PD. METHODS A total of 23 individuals with PD, in both off (PDOFF) and on (PDON) medication states, and 30 healthy older adults (control group [CG]) performed unobstructed walking and obstacle avoidance conditions. Cortical activity was acquired through a combined functional near-infrared spectroscopy electroencephalography (EEG) system, along with gait parameters, through an electronic carpet. Prefrontal cortex (PFC) oxygenated hemoglobin (HbO2) and EEG absolute power from FCz, Cz, and CPz channels were calculated. RESULTS HbO2 concentration reduced for people with PDOFF during obstacle avoidance compared with unobstructed walking. In contrast, both people with PDON and the CG had increased HbO2 concentration when avoiding obstacles compared with unobstructed walking. Dopaminergic medication increased step length, step velocity, and β and γ power in the CPz channel, regardless of walking condition. Moreover, dopaminergic-related changes (ie, on-off) in FCz/CPz γ power were associated with dopaminergic-related changes in step length for both walking conditions. CONCLUSIONS PD compromises the activation of the PFC during obstacle avoidance, and dopaminergic medication facilitates its recruitment. In addition, PD medication increases sensorimotor integration during walking by increasing posterior parietal cortex (CPz) activity. Increased γ power in the CPz and FCz channels is correlated with step length improvements achieved with dopaminergic medication during unobstructed walking and obstacle avoidance in PD.
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Affiliation(s)
- Diego Orcioli-Silva
- São Paulo State University (UNESP), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, São Paulo, Brazil
| | - Rodrigo Vitório
- São Paulo State University (UNESP), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, São Paulo, Brazil
| | - Priscila Nóbrega-Sousa
- São Paulo State University (UNESP), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, São Paulo, Brazil
| | - Victor Spiandor Beretta
- São Paulo State University (UNESP), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, São Paulo, Brazil
| | - Núbia Ribeiro da Conceição
- São Paulo State University (UNESP), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, São Paulo, Brazil
| | | | - Marcelo Pinto Pereira
- São Paulo State University (UNESP), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, São Paulo, Brazil
| | - Lilian Teresa Bucken Gobbi
- São Paulo State University (UNESP), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, São Paulo, Brazil
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22
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Mori A. How do adenosine A 2A receptors regulate motor function? Parkinsonism Relat Disord 2020; 80 Suppl 1:S13-S20. [PMID: 33349575 DOI: 10.1016/j.parkreldis.2020.09.025] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/14/2020] [Accepted: 09/15/2020] [Indexed: 01/17/2023]
Abstract
Adenosine A2A receptor antagonism is a new therapeutic strategy in the symptomatic treatment of Parkinson's disease (PD). This review addresses how adenosine A2A receptors are involved with the control of motor function via the basal ganglia-thalamocortical circuit, and considers the anatomical localization and physiological function of the receptor, along with its ultrastructural localization in critical areas/neurons of the circuit. Based on this understanding of the functional significance of the adenosine A2A receptor in the basal ganglia, the mode of action of A2A receptor antagonists is explored in terms of the dynamic functioning of the basal ganglia and the activity of the internal circuits of the striatum in PD. Finally, the pathophysiological differences between the normal and PD states are examined to emphasize the importance of the adenosine A2A receptor.
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23
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Nardone R, Höller Y, Brigo F, Versace V, Sebastianelli L, Florea C, Schwenker K, Golaszewski S, Saltuari L, Trinka E. Spinal cord involvement in Lewy body-related α-synucleinopathies. J Spinal Cord Med 2020; 43:832-845. [PMID: 30620687 PMCID: PMC7808259 DOI: 10.1080/10790268.2018.1557863] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Context: Lewy body (LB)-related α-synucleinopathy (LBAS) is the neuropathological hallmark of several neurodegenerative diseases such as Parkinson disease (PD), but it is also found in neurologically asymptomatic subjects. An abnormal accumulation of α-synuclein has been reported also in the spinal cord, but extent and significance of the spinal cord involvement are still poorly defined. Objective: We aimed to review the studies addressing the spinal cord involvement of LBAS in healthy subjects and in patients with PD or other neurodegenerative diseases. Methods: A MEDLINE search was performed using following terms: "spinal cord", " α-synucleinopathy", "α-synuclein", "Lewy body", "Parkinson's disease", "multiple system atrophy", "neurodegenerative disorder". Results: LBAS in the spinal cord is associated with that of the medullary reticular formation and locus ceruleus in the brainstem but not with that in the olfactory bulb and amygdala. The intermediolateral columns of the thoracic and sacral cord are the most frequently and severely affected region of the spinal cord. LBAS occurs in centrally projecting spinal cord neurons integrating pain, in particular from lower body periphery. It also involves the sacral parasympathetic nucleus innervating the smooth muscles of the bladder and distal colon and the Onuf's nucleus innervating the striated sphincters. The spinal cord lesions may thus play a crucial role in the genesis of frequent non-motor symptoms such as pain, urinary symptoms, bowel dysfunction, autonomic failure including orthostatic hypotension and sexual disturbances. Moreover, these may also contribute to the motor symptoms, since α-synuclein inclusions have been observed in the pyramidal tracts of patients with PD and multiple system atrophy. Conclusion: Recognition of this peculiar spinal cord pathology may help in the management of the related symptoms in subjects affected by α-synucleinopathies.
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Affiliation(s)
- Raffaele Nardone
- Department of Neurology, Franz Tappeiner Hospital, Merano, Italy,Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria,Spinal Cord Injury and Tissue Regeneration Center, Salzburg, Austria,Karl Landsteiner Institut für Neurorehabilitation und Raumfahrtneurologie, Salzburg, Austria,Correspondence to: Dr. Raffaele Nardone, Department of Neurology, “F. Tappeiner” Hospital, Merano, Via Rossini, Merano, BZ 5 39012, Italy; Ph: 0473/264616, 0473/264449. Color versions of one or more of the figures in the article can be found online at www.tandfonline.com/yscm
| | - Yvonne Höller
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria
| | - Francesco Brigo
- Department of Neurology, Franz Tappeiner Hospital, Merano, Italy,Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Verona, Italy
| | - Viviana Versace
- Department of Neurorehabilitation, Hospital of Vipiteno, Vipiteno, Italy,Research Unit for Neurorehabilitation South Tyrol, Bolzano, Italy
| | - Luca Sebastianelli
- Department of Neurorehabilitation, Hospital of Vipiteno, Vipiteno, Italy,Research Unit for Neurorehabilitation South Tyrol, Bolzano, Italy
| | - Cristina Florea
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria
| | - Kerstin Schwenker
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria,Karl Landsteiner Institut für Neurorehabilitation und Raumfahrtneurologie, Salzburg, Austria
| | - Stefan Golaszewski
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria,Karl Landsteiner Institut für Neurorehabilitation und Raumfahrtneurologie, Salzburg, Austria
| | - Leopold Saltuari
- Department of Neurorehabilitation, Hospital of Vipiteno, Vipiteno, Italy,Research Unit for Neurorehabilitation South Tyrol, Bolzano, Italy,Department of Neurology, Hochzirl Hospital, Zirl, Austria
| | - Eugen Trinka
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria,Spinal Cord Injury and Tissue Regeneration Center, Salzburg, Austria,Centre for Cognitive Neurosciences Salzburg, Salzburg, Austria,University for Medical Informatics and Health Technology, UMIT, Hall in Tirol, Austria
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24
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Beretta VS, Conceição NR, Nóbrega-Sousa P, Orcioli-Silva D, Dantas LKBF, Gobbi LTB, Vitório R. Transcranial direct current stimulation combined with physical or cognitive training in people with Parkinson's disease: a systematic review. J Neuroeng Rehabil 2020; 17:74. [PMID: 32539819 PMCID: PMC7296764 DOI: 10.1186/s12984-020-00701-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 05/21/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Pharmacologic therapy is the primary treatment used to manage Parkinson's disease (PD) symptoms. However, it becomes less effective with time and some symptoms do not respond to medication. Complementary interventions are therefore required for PD. Recent studies have implemented transcranial direct current stimulation (tDCS) in combination with other modalities of interventions, such as physical and cognitive training. Although the combination of tDCS with physical and cognitive training seems promising, the existing studies present mixed results. Therefore, a systematic review of the literature is necessary. AIMS This systematic review aims to (i) assess the clinical effects of tDCS when applied in combination with physical or cognitive therapies in people with PD and; (ii) analyze how specific details of the intervention protocols may relate to findings. METHODS The search strategy detailed the technique of stimulation, population and combined interventions (i.e. cognitive and/or physical training). Only controlled studies were included. RESULTS Seventeen of an initial yield of 408 studies satisfied the criteria. Studies involved small sample sizes. tDCS protocols and characteristics of combined interventions varied. The reviewed studies suggest that synergistic effects may be obtained for cognition, upper limb function, gait/mobility and posture when tDCS is combined with cognitive and/or motor interventions in PD. CONCLUSION The reported results encourage further research to better understand the therapeutic utility of tDCS and to inform optimal clinical use in PD. Future studies in this field should focus on determining optimal stimulation parameters and intervention characteristics for maximal benefits in people with PD.
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Affiliation(s)
- Victor Spiandor Beretta
- Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (Unesp), Avenue 24-A, 1515, Bela Vista, Rio Claro, São Paulo State, 13506-900, Brazil
- Graduate Program in Movement Sciences, São Paulo State University - UNESP, Rio Claro, São Paulo State, Brazil
| | - Núbia Ribeiro Conceição
- Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (Unesp), Avenue 24-A, 1515, Bela Vista, Rio Claro, São Paulo State, 13506-900, Brazil
- Graduate Program in Movement Sciences, São Paulo State University - UNESP, Rio Claro, São Paulo State, Brazil
| | - Priscila Nóbrega-Sousa
- Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (Unesp), Avenue 24-A, 1515, Bela Vista, Rio Claro, São Paulo State, 13506-900, Brazil
- Graduate Program in Movement Sciences, São Paulo State University - UNESP, Rio Claro, São Paulo State, Brazil
| | - Diego Orcioli-Silva
- Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (Unesp), Avenue 24-A, 1515, Bela Vista, Rio Claro, São Paulo State, 13506-900, Brazil
- Graduate Program in Movement Sciences, São Paulo State University - UNESP, Rio Claro, São Paulo State, Brazil
| | - Luana Karla Braz Fonseca Dantas
- Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (Unesp), Avenue 24-A, 1515, Bela Vista, Rio Claro, São Paulo State, 13506-900, Brazil
| | - Lilian Teresa Bucken Gobbi
- Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (Unesp), Avenue 24-A, 1515, Bela Vista, Rio Claro, São Paulo State, 13506-900, Brazil
- Graduate Program in Movement Sciences, São Paulo State University - UNESP, Rio Claro, São Paulo State, Brazil
| | - Rodrigo Vitório
- Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (Unesp), Avenue 24-A, 1515, Bela Vista, Rio Claro, São Paulo State, 13506-900, Brazil.
- Graduate Program in Movement Sciences, São Paulo State University - UNESP, Rio Claro, São Paulo State, Brazil.
- Department of Neurology, Oregon Health and Science University, Portland, Oregon, USA.
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25
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Akula SK, McCullough KB, Weichselbaum C, Dougherty JD, Maloney SE. The trajectory of gait development in mice. Brain Behav 2020; 10:e01636. [PMID: 32333523 PMCID: PMC7303394 DOI: 10.1002/brb3.1636] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 02/13/2020] [Accepted: 03/19/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Gait irregularities are prevalent in neurodevelopmental disorders (NDDs). However, there is a paucity of information on gait phenotypes in NDD experimental models. This is in part due to the lack of understanding of the normal developmental trajectory of gait maturation in the mouse. MATERIALS AND METHODS Using the DigiGait system, we have developed a quantitative, standardized, and reproducible assay of developmental gait metrics in commonly used mouse strains that can be added to the battery of mouse model phenotyping. With this assay, we characterized the trajectory of gait in the developing C57BL/6J and FVB/AntJ mouse lines. RESULTS In both lines, a mature stride consisted of 40% swing and 60% stance in the forelimbs, which mirrors the mature human stride. In C57BL/6J mice, developmental trajectories were observed for stance width, paw overlap distance, braking and propulsion time, rate of stance loading, peak paw area, and metrics of intraindividual variability. In FVB/AntJ mice, developmental trajectories were observed for percent shared stance, paw overlap distance, rate of stance loading, and peak paw area, although in different directions than C57 mice. By accounting for the impact of body length on stride measurements, we demonstrate the importance of considering body length when interpreting gait metrics. CONCLUSION Overall, our results show that aspects of mouse gait development parallel a timeline of normal human gait development, such as the percent of stride that is stance phase and swing phase. This study may be used as a standard reference for developmental gait phenotyping of murine models, such as models of neurodevelopmental disease.
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Affiliation(s)
- Shyam K Akula
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.,Department of Genetics, Washington University School of Medicine, St. Louis, MO, USA.,Harvard-MIT MD/PhD Program, Harvard Medical School, Boston, MA, USA
| | - Katherine B McCullough
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.,Department of Genetics, Washington University School of Medicine, St. Louis, MO, USA
| | - Claire Weichselbaum
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.,Department of Genetics, Washington University School of Medicine, St. Louis, MO, USA
| | - Joseph D Dougherty
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.,Department of Genetics, Washington University School of Medicine, St. Louis, MO, USA.,Intellectual and Developmental Disabilities Research Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Susan E Maloney
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.,Intellectual and Developmental Disabilities Research Center, Washington University School of Medicine, St. Louis, MO, USA
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26
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Orcioli-Silva D, Vitório R, Nóbrega-Sousa P, da Conceição NR, Beretta VS, Lirani-Silva E, Gobbi LTB. Levodopa Facilitates Prefrontal Cortex Activation During Dual Task Walking in Parkinson Disease. Neurorehabil Neural Repair 2020; 34:589-599. [DOI: 10.1177/1545968320924430] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background. Although dopaminergic medication improves dual task walking in people with Parkinson disease (PD), the underlying neural mechanisms are not yet fully understood. As prefrontal cognitive resources are involved in dual task walking, evaluation of the prefrontal cortex (PFC) is required. Objective. To investigate the effect of dopaminergic medication on PFC activity and gait parameters during dual task walking in people with PD. Methods. A total of 20 individuals with PD (69.8 ± 5.9 years) and 30 healthy older people (68.0 ± 5.6 years) performed 2 walking conditions: single and dual task (walking while performing a digit vigilance task). A mobile functional near infrared spectroscopy system and an electronic sensor carpet were used to analyze PFC activation and gait parameters, respectively. Relative concentrations of oxygenated hemoglobin (HbO2) from the left and right PFC were measured. Results. People with PD in the off state did not present changes in HbO2 level in the left PFC across walking conditions. In contrast, in the on state, they presented increased HbO2 levels during dual task compared with single task. Regardless of medication state, people with PD presented increased HbO2 levels in the right PFC during dual task walking compared with single task. The control group demonstrated increased PFC activity in both hemispheres during dual task compared with single task. People with PD showed increases in both step length and velocity in the on state compared with the off state. Conclusions. PD limits the activation of the left PFC during dual task walking, and dopaminergic medication facilitates its recruitment.
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Affiliation(s)
- Diego Orcioli-Silva
- Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (UNESP), Rio Claro, Brazil
- Graduate Program in Movement Sciences, São Paulo State University (UNESP), Rio Claro, Brazil
| | - Rodrigo Vitório
- Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (UNESP), Rio Claro, Brazil
- Graduate Program in Movement Sciences, São Paulo State University (UNESP), Rio Claro, Brazil
| | - Priscila Nóbrega-Sousa
- Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (UNESP), Rio Claro, Brazil
- Graduate Program in Movement Sciences, São Paulo State University (UNESP), Rio Claro, Brazil
| | - Núbia Ribeiro da Conceição
- Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (UNESP), Rio Claro, Brazil
- Graduate Program in Movement Sciences, São Paulo State University (UNESP), Rio Claro, Brazil
| | - Victor Spiandor Beretta
- Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (UNESP), Rio Claro, Brazil
- Graduate Program in Movement Sciences, São Paulo State University (UNESP), Rio Claro, Brazil
| | - Ellen Lirani-Silva
- Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (UNESP), Rio Claro, Brazil
- Graduate Program in Movement Sciences, São Paulo State University (UNESP), Rio Claro, Brazil
| | - Lilian Teresa Bucken Gobbi
- Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (UNESP), Rio Claro, Brazil
- Graduate Program in Movement Sciences, São Paulo State University (UNESP), Rio Claro, Brazil
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27
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Liang S, Yu Y, Li H, Wang Y, Cheng Y, Yang H. The Study of Subthalamic Deep Brain Stimulation for Parkinson Disease-Associated Camptocormia. Med Sci Monit 2020; 26:e919682. [PMID: 32222721 PMCID: PMC7139194 DOI: 10.12659/msm.919682] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 01/15/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Camptocormia is an axis symptom of Parkinson disease. It remains uncertain whether treatment with medications and surgery are effective. In this study, we assessed the efficacy of subthalamic nucleus deep brain stimulation (STN DBS) in Parkinson disease-associated camptocormia and explored some of its mechanisms. MATERIAL AND METHODS Parkinson disease-associated camptocormia was diagnosed by the following procedures. All patients underwent bilateral STN DBS. The patents' camptocormia was rated by degree and MDS Unified Parkinson's Disease Rating Scale (UPDRS) item 3.13 before and after DBS surgery. Rehabilitation and psychological interventions were used after surgery, in addition to adjustments of medication and stimulus parameters. The treatment effects on camptocormia were assessed comparing medication-off (presurgery) versus stimulation-on (post-surgery). Ethical approval for this study was provided through the Center of Human Research Ethics Committee (No. 2019-35). This study trial was registered in Chinese Clinical Trial Registry (No. ChiCTR1900022655). All the participants provided written informed consent. RESULTS After DBS surgery, all of study patients' symptoms were improved, with different levels of improvement. The minimum and maximum improvement rates were 20% and 100% respectively. The score of item 3.13 of the MDS-UPDRS III and the degree of camptocormia were found to be obviously improved (P<0.05). CONCLUSIONS STN DBS can improve Parkinson disease-associated camptocormia; STN DBS assisted with rehabilitation and psychological intervention appears to be more effective.
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Affiliation(s)
- Siquan Liang
- Department of Neurosurgery, Tianjin Huanhu Hosptial, Tianjin, P.R. China
| | - Yang Yu
- Department of Neurological Rehabilitation, Tianjin Huanhu Hosptial, Tianjin, P.R. China
| | - Haitao Li
- Department of Neurosurgery, Tianjin Huanhu Hosptial, Tianjin, P.R. China
| | - Yue Wang
- Department of Neurological Rehabilitation, Tianjin Huanhu Hosptial, Tianjin, P.R. China
| | - Yuanyuan Cheng
- Department of Neurological Rehabilitation, Tianjin Huanhu Hosptial, Tianjin, P.R. China
| | - Hechao Yang
- Department of Psychology, Tianjin Huanhu Hosptial, Tianjin, P.R. China
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28
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Delval A, Bayot M, Defebvre L, Dujardin K. Cortical Oscillations during Gait: Wouldn't Walking be so Automatic? Brain Sci 2020; 10:E90. [PMID: 32050471 PMCID: PMC7071606 DOI: 10.3390/brainsci10020090] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 02/03/2020] [Accepted: 02/07/2020] [Indexed: 01/12/2023] Open
Abstract
Gait is often considered as an automatic movement but cortical control seems necessary to adapt gait pattern with environmental constraints. In order to study cortical activity during real locomotion, electroencephalography (EEG) appears to be particularly appropriate. It is now possible to record changes in cortical neural synchronization/desynchronization during gait. Studying gait initiation is also of particular interest because it implies motor and cognitive cortical control to adequately perform a step. Time-frequency analysis enables to study induced changes in EEG activity in different frequency bands. Such analysis reflects cortical activity implied in stabilized gait control but also in more challenging tasks (obstacle crossing, changes in speed, dual tasks…). These spectral patterns are directly influenced by the walking context but, when analyzing gait with a more demanding attentional task, cortical areas other than the sensorimotor cortex (prefrontal, posterior parietal cortex, etc.) seem specifically implied. While the muscular activity of legs and cortical activity are coupled, the precise role of the motor cortex to control the level of muscular contraction according to the gait task remains debated. The decoding of this brain activity is a necessary step to build valid brain-computer interfaces able to generate gait artificially.
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Affiliation(s)
- Arnaud Delval
- UMR-S1172, Lille Neuroscience & Cognition, Inserm, University Lille, 59000 Lille, France; (M.B.); (L.D.); (K.D.)
- Clinical Neurophysiology Department, CHU Lille, 59000 Lille, France
| | - Madli Bayot
- UMR-S1172, Lille Neuroscience & Cognition, Inserm, University Lille, 59000 Lille, France; (M.B.); (L.D.); (K.D.)
- Clinical Neurophysiology Department, CHU Lille, 59000 Lille, France
| | - Luc Defebvre
- UMR-S1172, Lille Neuroscience & Cognition, Inserm, University Lille, 59000 Lille, France; (M.B.); (L.D.); (K.D.)
- Movement Disorders Department, CHU Lille, 59000 Lille, France
| | - Kathy Dujardin
- UMR-S1172, Lille Neuroscience & Cognition, Inserm, University Lille, 59000 Lille, France; (M.B.); (L.D.); (K.D.)
- Movement Disorders Department, CHU Lille, 59000 Lille, France
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29
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Muthukrishnan N, Abbas JJ, Shill HA, Krishnamurthi N. Cueing Paradigms to Improve Gait and Posture in Parkinson's Disease: A Narrative Review. SENSORS 2019; 19:s19245468. [PMID: 31835870 PMCID: PMC6960538 DOI: 10.3390/s19245468] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 12/09/2019] [Accepted: 12/09/2019] [Indexed: 12/24/2022]
Abstract
Progressive gait dysfunction is one of the primary motor symptoms in people with Parkinson’s disease (PD). It is generally expressed as reduced step length and gait speed and as increased variability in step time and step length. People with PD also exhibit stooped posture which disrupts gait and impedes social interaction. The gait and posture impairments are usually resistant to the pharmacological treatment, worsen as the disease progresses, increase the likelihood of falls, and result in higher rates of hospitalization and mortality. These impairments may be caused by perceptual deficiencies (poor spatial awareness and loss of temporal rhythmicity) due to the disruptions in processing intrinsic information related to movement initiation and execution which can result in misperceptions of the actual effort required to perform a desired movement and maintain a stable posture. Consequently, people with PD often depend on external cues during execution of motor tasks. Numerous studies involving open-loop cues have shown improvements in gait and freezing of gait (FoG) in people with PD. However, the benefits of cueing may be limited, since cues are provided in a consistent/rhythmic manner irrespective of how well a person follows them. This limitation can be addressed by providing feedback in real-time to the user about performance (closed-loop cueing) which may help to improve movement patterns. Some studies that used closed-loop cueing observed improvements in gait and posture in PD, but the treadmill-based setup in a laboratory would not be accessible outside of a research setting, and the skills learned may not readily and completely transfer to overground locomotion in the community. Technologies suitable for cueing outside of laboratory environments could facilitate movement practice during daily activities at home or in the community and could strongly reinforce movement patterns and improve clinical outcomes. This narrative review presents an overview of cueing paradigms that have been utilized to improve gait and posture in people with PD and recommends development of closed-loop wearable systems that can be used at home or in the community to improve gait and posture in PD.
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Affiliation(s)
- Niveditha Muthukrishnan
- Center for Adaptive Neural Systems, School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ 85287, USA; (N.M.); (J.J.A.)
| | - James J. Abbas
- Center for Adaptive Neural Systems, School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ 85287, USA; (N.M.); (J.J.A.)
| | - Holly A. Shill
- Muhammad Ali Parkinson Center, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ 85013, USA;
| | - Narayanan Krishnamurthi
- Center for Adaptive Neural Systems, School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ 85287, USA; (N.M.); (J.J.A.)
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ 85004, USA
- Correspondence: ; Tel.: +1-(602)-496-0912
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Roberts DR, Asemani D, Nietert PJ, Eckert MA, Inglesby DC, Bloomberg JJ, George MS, Brown TR. Prolonged Microgravity Affects Human Brain Structure and Function. AJNR Am J Neuroradiol 2019; 40:1878-1885. [PMID: 31624117 PMCID: PMC6975111 DOI: 10.3174/ajnr.a6249] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 08/19/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE Widespread brain structural changes are seen following extended spaceflight missions. The purpose of this study was to investigate whether these structural changes are associated with alterations in motor or cognitive function. MATERIALS AND METHODS Brain MR imaging scans of National Aeronautics and Space Administration astronauts were retrospectively analyzed to quantify pre- to postflight changes in brain structure. Local structural changes were assessed using the Jacobian determinant. Structural changes were compared with clinical findings and cognitive and motor function. RESULTS Long-duration spaceflights aboard the International Space Station, but not short-duration Space Shuttle flights, resulted in a significant increase in total ventricular volume (10.7% versus 0%, P < .001, n = 12 versus n = 7). Total ventricular volume change was significantly associated with mission duration (r = 0.72, P = .001, n = 19) but negatively associated with age (r = -0.48, P = .048, n = 19). Long-duration spaceflights resulted in significant crowding of brain parenchyma at the vertex. Pre- to postflight structural changes of the left caudate correlated significantly with poor postural control; and the right primary motor area/midcingulate correlated significantly with a complex motor task completion time. Change in volume of 3 white matter regions significantly correlated with altered reaction times on a cognitive performance task (bilateral optic radiations, splenium of the corpus callosum). In a post hoc finding, astronauts who developed spaceflight-associated neuro-ocular syndrome demonstrated smaller changes in total ventricular volume than those who did not (12.8% versus 6.5%, n = 8 versus n = 4). CONCLUSIONS While cautious interpretation is appropriate given the small sample size and number of comparisons, these findings suggest that brain structural changes are associated with changes in cognitive and motor test scores and with the development of spaceflight-associated neuro-optic syndrome.
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Affiliation(s)
- D R Roberts
- From the Departments of Radiology and Radiological Science (D.R.R., D.A., D.I., T.R.B.)
- Department of Neurosciences (D.R.R.)
| | - D Asemani
- From the Departments of Radiology and Radiological Science (D.R.R., D.A., D.I., T.R.B.)
| | | | - M A Eckert
- Otolaryngology-Head and Neck Surgery (M.A.E.)
| | - D C Inglesby
- From the Departments of Radiology and Radiological Science (D.R.R., D.A., D.I., T.R.B.)
| | - J J Bloomberg
- Neurosciences Laboratory (J.J.B.), NASA Johnson Space Center, Houston, Texas
| | - M S George
- Psychiatry and Behavioral Sciences (M.S.G.), Medical University of South Carolina, Charleston, South Carolina
- Ralph H. Johnson VA Medical Center (M.S.G.), Charleston, South Carolina
| | - T R Brown
- From the Departments of Radiology and Radiological Science (D.R.R., D.A., D.I., T.R.B.)
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Radovanović S, Vodopić S, Stanković I, Dragašević-Mišković N, Kostić V. Spatiotemporal gait characteristics of Huntington’s disease during dual-task walking. Int J Neurosci 2019; 130:136-143. [DOI: 10.1080/00207454.2019.1667781] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Saša Radovanović
- Institute for Medical Research, University of Belgrade, Belgrade, Serbia
| | - Sanja Vodopić
- Department of Neurology, Clinical Centre of Montenegro, Podgorica, Montenegro
| | - Iva Stanković
- Neurology Clinic, School of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Vladimir Kostić
- Neurology Clinic, School of Medicine, University of Belgrade, Belgrade, Serbia
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Giusti Rossi P, Pires de Andrade L, Hotta Ansai J, Silva Farche AC, Carnaz L, Dalpubel D, Ferriolli E, Assis Carvalho Vale F, de Medeiros Takahashi AC. Dual-Task Performance: Influence of Frailty, Level of Physical Activity, and Cognition. J Geriatr Phys Ther 2019. [DOI: 10.1519/jpt.0000000000000182] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Pelicioni PHS, Tijsma M, Lord SR, Menant J. Prefrontal cortical activation measured by fNIRS during walking: effects of age, disease and secondary task. PeerJ 2019; 7:e6833. [PMID: 31110922 PMCID: PMC6501770 DOI: 10.7717/peerj.6833] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 03/22/2019] [Indexed: 01/09/2023] Open
Abstract
Background Cognitive processes are required during walking to appropriately respond to environmental and task demands. There are now many studies that have used functional Near-Infrared Spectroscopy (fNIRS) to record brain activation to investigate neural bases of cognitive contributions in gait. The aim of this systematic review was to summarize the published research regarding Prefrontal cortical (PFC) activation patterns during simple and complex walking tasks in young adults, older adults and clinical groups with balance disorders using fNIRS. Our secondary aim was to evaluate each included study based on methodological reporting criteria important for good data quality. Methods We conducted searches in June 2018 using four databases: Embase, PubMed, Scopus and PsycINFO. The strategy search used was: (((((near infrared spectroscopy) OR functional near infrared spectroscopy) OR nirs) OR fnirs) AND (((gait) OR walking) OR locomotion) AND (((((young) OR adult) OR older) OR elderly) NOT children)) AND (((Brain) OR cortex) OR cortical) for our search. The papers included met the specific review criteria: (i) used fNIRS to measure PFC activation patterns; (ii) included walking tasks (simple and complex) and; (iii) assessed young people, older people and/or clinical groups with balance disorders. Results Thirty five (describing 75 brain activation comparisons) of the 308 studies retrieved through our search met the inclusion criteria. Based on 6 methodological reporting considerations, 20 were of high quality, 10 were of medium quality and 5 were of low quality. Eleven/20 comparisons in young people, 23/37 comparisons in older people and 15/18 comparisons in clinical groups reported increased PFC activation with increased walking task complexity. The majority of comparisons that used verbal fluency, counting backwards or secondary motor tasks reported increases in PFC activation (83%, 64% and 58% of these studies, respectively). In contrast, no studies found secondary visual tasks increased PFC activation. Conclusion Increased PFC activation was most common in studies that involved walks comprising secondary verbal fluency and arithmetic tasks. Clinical groups generally showed increased PFC activation irrespective of type of secondary task performed during walking which suggests these groups require more attentional resources for safe walking. Systematic review registration number: PROSPERO 2017 - CRD42017059501.
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Affiliation(s)
- Paulo H S Pelicioni
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, NSW, Australia.,School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | | | - Stephen R Lord
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, NSW, Australia.,School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Jasmine Menant
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, NSW, Australia.,School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
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Tsang AR, Rajakumar N, Jog MS. Intrapallidal injection of botulinum toxin A recovers gait deficits in a parkinsonian rodent model. Acta Physiol (Oxf) 2019; 226:e13230. [PMID: 30506881 DOI: 10.1111/apha.13230] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 10/29/2018] [Accepted: 11/24/2018] [Indexed: 12/28/2022]
Abstract
AIM Modulation of electrical activity in the subthalamic nucleus has been therapeutically effective in Parkinson's disease. Pharmacological manipulation of glutamate release from subthalamic neurons could also favourably alter basal ganglia activity to improve motor symptoms. This study investigates the efficacy of selective suppression of hyperactive glutamatergic input from the subthalamic nucleus to the globus pallidus internal segment by botulinum toxin A (BoNT-A) in a parkinsonian model. METHODS Unilateral 6-hydroxydopamine lesioned parkinsonian rodents and controls received microinfusions of BoNT-A or vehicle into the ipsilateral internal globus pallidus (n = 8 per group). Changes in gait were measured by the CatWalk apparatus, along with assessment of apomorphine-induced rotational behaviour prior to and following BoNT-A injection. Immunofluorescent staining for markers of glutamatergic, GABAergic and total terminals was performed at the internal globus pallidus. RESULTS Administration of a single dose of BoNT-A (0.5 ng) significantly improved the rotational asymmetry and gait abnormalities. Ameliorations in speed, body speed variation, cadence and walking pattern were comparable to pre-lesioned animals, and persisted up to 1 month following BoNT-A injection. These changes are associated to BoNT-A's ability to selectively target glutamatergic terminals. CONCLUSION Blockade of subthalamic hyperactivity by BoNT-A leads to sufficient reorganization in the basal ganglia needed to generate a consistent rhythmic pattern of walking. This suggests the potential use of intracerebral BoNT-A to produce effective neuromodulation in the parkinsonian brain, as well as expansion into other neurodegenerative disorders linked to excitotoxity.
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Affiliation(s)
- Adrianna R. Tsang
- Department of Physiology and Pharmacology Western University London Ontario Canada
| | | | - Mandar S. Jog
- Department of Physiology and Pharmacology Western University London Ontario Canada
- Department of Clinical Neurological Sciences London Health Sciences Centre London Ontario Canada
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Purcell NL, Goldman JG, Ouyang B, Bernard B, O'Keefe JA. The Effects of Dual-Task Cognitive Interference and Environmental Challenges on Balance in Huntington's Disease. Mov Disord Clin Pract 2019; 6:202-212. [PMID: 30949551 PMCID: PMC6417749 DOI: 10.1002/mdc3.12720] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 12/05/2018] [Accepted: 12/07/2018] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Huntington's disease (HD) is characterized by chorea, balance and gait impairments, and cognitive deficits, which increase fall risk. Dual task (DT) and environmentally challenging paradigms reflect balance related to everyday life. Furthermore, the impact of cognitive deficits on balance dysfunction and falls in HD is unknown. OBJECTIVE To determine the impact of DT interference, sensory feedback, and cognitive performance on balance and falls in HD. METHODS Seventeen participants with HD (55 ± 9.7 years) and 17 age-matched controls (56.5 ± 9.3 years) underwent quantitative balance testing with APDM inertial sensors. Postural sway was assessed during conditions of manipulated stance, vision, proprioception, and cognitive demand. The DT was a concurrent verbal fluency task. Neuropsychological assessments testing multiple cognitive domains were also administered. RESULTS HD participants exhibited significantly greater total sway area, jerk, and variability under single-task (ST) and DT conditions compared to controls (P = 0.0002 - < 0.0001). They also demonstrated greater DT interference with vision removed for total sway area (P = 0.01) and variability (P = 0.02). Significantly worse postural control was observed in HD with vision removed and reduced proprioception (P = 0.001 - 0.01). Decreased visuospatial performance correlated with greater total sway and jerk (P = 0.01; 0.009). No balance parameters correlated with retrospective falls in HD. CONCLUSIONS HD participants have worse postural control under DT, limited proprioception/vision, and greater DT interference with a narrowed base and no visual input. These findings may have implications for designing motor and cognitive strategies to improve balance in HD.
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Affiliation(s)
| | - Jennifer G. Goldman
- Department of Neurological Sciences, Section of Parkinson Disease and Movement DisordersRush University Medical CenterChicagoILUSA
| | - Bichun Ouyang
- Department of Neurological Sciences, Section of Parkinson Disease and Movement DisordersRush University Medical CenterChicagoILUSA
| | - Bryan Bernard
- Department of Neurological Sciences, Section of Parkinson Disease and Movement DisordersRush University Medical CenterChicagoILUSA
| | - Joan A. O'Keefe
- Department of Cell and Molecular MedicineRush University Medical CenterChicagoILUSA
- Department of Neurological Sciences, Section of Parkinson Disease and Movement DisordersRush University Medical CenterChicagoILUSA
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Wright WG. Tonic Neuromuscular Processing Affects Postural Adaptation Differently in Aging and Parkinson's Disease. Front Neurol 2019; 9:1130. [PMID: 30719020 PMCID: PMC6348245 DOI: 10.3389/fneur.2018.01130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 12/10/2018] [Indexed: 11/13/2022] Open
Abstract
The combination of phasic and tonic neuromuscular processes are involved in the maintenance of normal upright posture. The latter is of particular importance in some pathologies, such as Parkinson's Disease (PD), which is known by one of its cardinal symptoms—tonic dysfunction (i.e., rigidity). Changes in tonic function may also occur during healthy aging. In this investigation, somatosensory input was manipulated by changing the support surface orientation for prolonged periods of quiet stance (QS). The aim was to shed light on how long-term tonic responses called postural lean after-effects are affected by aging and age-related neuropathology. Forty one participants were tested: 19 healthy young (25±5 years), 13 healthy older (63±8 years), and 9 adults with PD (63±5 years). Baseline conditions were eyes-closed QS on a stable surface or standing on an unstable, sway-referenced (SR) surface. Four experimental conditions combined two types of toes-up ramp tilt adaptation (120 s of toes-up static 7° tilt or sinusoidal 7° ± 3° tilt) with two types of post-adaptation (120 s of QS or SR). Results revealed postural after-effects during post-adaptation QS showing significant anterior COP shift for both young and older adults (p < 0.0001), but not PD (p > 0.06, n.s.). Compared to young, postural after-effects in older adults showed longer decay constants and did not return to baseline COP within the 120 s post-adaptation period (p < 0.05). Postural after-effects during SR, which appeared as toes-up surface tilt were highly significant in healthy populations (p = 0.001), but took longer to develop in PD. Younger adults showed significantly larger dorsiflexion (p < 0.01) and faster decay constants than older adults (p < 0.05). In summary, (1) postural after-effects decayed to baseline when post-tilt surface was stable but were retained and even grew larger post-adaptation in the SR surface conditions in all groups, (2) postural after-effects differed between healthy age groups, (3) PD showed less adaptation to surface changes. Differences in size and decay of after-effects between healthy and PD groups suggest tonic neuromuscular processes play a role in how adaptable postural control is to changing surface conditions and this is affected by healthy aging and basal ganglia function.
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Affiliation(s)
- W Geoffrey Wright
- Neuromotor Sciences Program, College of Public Health, Temple University, Philadelphia, PA, United States
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Chastan N, Bair WN, Resnick SM, Studenski SA, Decker LM. Prediagnostic markers of idiopathic Parkinson's disease: Gait, visuospatial ability and executive function. Gait Posture 2019; 68:500-505. [PMID: 30616180 DOI: 10.1016/j.gaitpost.2018.12.039] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 10/24/2018] [Accepted: 12/25/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Idiopathic Parkinson's disease (IPD) has a long preclinical phase. RESEARCH QUESTION This study assesses data on prediagnostic markers of IPD from a longitudinal, natural history study of aging. METHODS Participants were selected from the database of the Baltimore Longitudinal Study of Aging, and included 10 prediagnosed IPD cases (eight men and two women) and 30 age and sex matched healthy controls. Patients with prediagnosed IPD had already had an assessment for IPD 2.6 ± 1.3 years (range 1.0-5.3 years) before the actual diagnosis, including: gait speed (six-meter corridor walk), spatio-temporal gait parameters using Vicon motion capture, balance, upper-limb motor skills, neuropsychological profile, and non-motor symptoms. RESULTS Prediagnosed IPD cases compared to controls had slower gait speed (Δ=-0.13 m.s-1, p = 0.03) due to shorter step length (Δ=-5 cm, p = 0.004), worse visuospatial ability (card rotation test, Δ=-42, p = 0.0001) and worse executive function (category fluency test, Δ=-2.6, p = 0.04). SIGNIFICANCE Our findings identify dimensions that merit further study as prediagnostic markers of Idiopathic Parkinson's disease to identify patients who might benefit from future neuroprotective therapy in order to delay, or prevent, clinical manifestations.
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Affiliation(s)
- Nathalie Chastan
- Normandie Univ, UNICAEN, INSERM, COMETE, F 14000, Caen, France; Rouen University Hospital, Department of Neurophysiology, F 76000, Rouen, France.
| | - Woei-Nan Bair
- Longitudinal Studies Section, Translational Gerontology Branch, National Institute on Aging, Baltimore, MD, 21224, USA
| | - Susan M Resnick
- Longitudinal Studies Section, Translational Gerontology Branch, National Institute on Aging, Baltimore, MD, 21224, USA
| | - Stephanie A Studenski
- Longitudinal Studies Section, Translational Gerontology Branch, National Institute on Aging, Baltimore, MD, 21224, USA
| | - Leslie M Decker
- Normandie Univ, UNICAEN, INSERM, COMETE, F 14000, Caen, France
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Valldeoriola F, Muñoz E, Rumià J, Roldán P, Cámara A, Compta Y, Martí MJ, Tolosa E. Simultaneous low-frequency deep brain stimulation of the substantia nigra pars reticulata and high-frequency stimulation of the subthalamic nucleus to treat levodopa unresponsive freezing of gait in Parkinson's disease: A pilot study. Parkinsonism Relat Disord 2018; 60:153-157. [PMID: 30241951 DOI: 10.1016/j.parkreldis.2018.09.008] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 09/04/2018] [Accepted: 09/04/2018] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Experimental studies suggest that low-frequency (LF) (63 Hz) deep brain stimulation (DBS) of the substantia nigra pars reticulata (SNr) could be useful to regulate gait disorders refractory to medical treatment in Parkinson's disease (PD). The SNr neurons could act as high-frequency (HF) pacemakers within locomotor control systems. Currently, no specific therapies can treat gait disorders in PD with insufficient response to dopaminergic treatment. OBJECTIVE To investigate whether LF-SNr-DBS combined with standard HF stimulation of the subthalamic nucleus (STN) is clinically relevant in improving gait disorders that no longer respond to levodopa in PD patients, compared with HF-STN or LF-SNr stimulation alone. METHODS Patients received LF-SNr or HF-STN stimulation alone or combined (COMB) stimulation of both nuclei (crossover design). The nucleus to be stimulated was randomly assigned and clinical evaluations performed by a blinded examiner after three months follow-up for each. Clinical assessment included the Freezing of Gait questionnaire, Tinetti Balance and Walking Assessing tool, and Unified Parkinson's Disease Rating. RESULTS We included six patients (mean age 59.1 years, disease duration 16.1 years). All patients suffered motor fluctuations and dyskinesias. The best results were obtained with COMB in four patients (who preferred and remained with COMB over 3 years of follow-up) and with HF-STN in two patients. SNr stimulation alone did not produce better results than COMB or STN in any patient. CONCLUSION COMB and HF-STN stimulation improved PD-associated gait disorders in this preliminary case series, sustained over time. Further multicenter investigations are required to better explore this therapeutic option.
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Affiliation(s)
- Francesc Valldeoriola
- Institut de Neurociències, Hospital Clínic de Barcelona, Universitat de Barcelona, Spain.
| | - Esteban Muñoz
- Institut de Neurociències, Hospital Clínic de Barcelona, Universitat de Barcelona, Spain
| | - Jordi Rumià
- Institut de Neurociències, Hospital Clínic de Barcelona, Universitat de Barcelona, Spain
| | - Pedro Roldán
- Institut de Neurociències, Hospital Clínic de Barcelona, Universitat de Barcelona, Spain
| | - Ana Cámara
- Institut de Neurociències, Hospital Clínic de Barcelona, Universitat de Barcelona, Spain
| | - Yaroslau Compta
- Institut de Neurociències, Hospital Clínic de Barcelona, Universitat de Barcelona, Spain
| | - María José Martí
- Institut de Neurociències, Hospital Clínic de Barcelona, Universitat de Barcelona, Spain
| | - Eduardo Tolosa
- Institut de Neurociències, Hospital Clínic de Barcelona, Universitat de Barcelona, Spain
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Dalrymple AN, Everaert DG, Hu DS, Mushahwar VK. A speed-adaptive intraspinal microstimulation controller to restore weight-bearing stepping in a spinal cord hemisection model. J Neural Eng 2018; 15:056023. [PMID: 30084388 DOI: 10.1088/1741-2552/aad872] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The goal of this study was to develop control strategies to produce alternating, weight-bearing stepping in a cat model of hemisection spinal cord injury (SCI) using intraspinal microstimulation (ISMS). APPROACH Six cats were anesthetized and the functional consequences of a hemisection SCI were simulated by manually moving one hind-limb through the gait cycle over a moving treadmill belt. ISMS activated the muscles in the other leg by stimulating motor networks in the lumbosacral enlargement using low levels of current (<110 µA). The control strategy used signals from ground reaction forces and angular velocity from the manually-moved limb to anticipate states of the gait cycle, and controlled ISMS to move the other hind-limb into the opposite state. Adaptive control strategies were developed to ensure weight-bearing at different stepping speeds. The step period was predicted using generalizations obtained through four supervised machine learning algorithms and used to adapt the control strategy for faster steps. MAIN RESULTS At a single speed, 100% of the steps had sufficient weight-bearing; at faster speeds without adaptation, 97.6% of steps were weight-bearing (significantly less than that for single speed; p = 0.002). By adapting the control strategy for faster steps using the predicted step period, weight-bearing was achieved in more than 99% of the steps in three of four methods (significantly more than without adaptation p < 0.04). Overall, a multivariate model tree increased the number of weight-bearing steps, restored step symmetry, and maintained alternation at faster stepping speeds. SIGNIFICANCE Through the adaptive control strategies guided by supervised machine learning, we were able to restore weight-bearing and maintain alternation and step symmetry at varying stepping speeds.
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Affiliation(s)
- Ashley N Dalrymple
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada. Sensory Motor Adaptive Rehabilitation Technology (SMART) Network, University of Alberta, Edmonton, AB, Canada
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Spike discharge characteristic of the caudal mesencephalic reticular formation and pedunculopontine nucleus in MPTP-induced primate model of Parkinson disease. Neurobiol Dis 2018; 128:40-48. [PMID: 30086388 DOI: 10.1016/j.nbd.2018.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 07/24/2018] [Accepted: 08/03/2018] [Indexed: 12/20/2022] Open
Abstract
The pedunculopontine nucleus (PPN) included in the caudal mesencephalic reticular formation (cMRF) plays a key role in the control of locomotion and wake state. Regarding its involvement in the neurodegenerative process observed in Parkinson disease (PD), deep brain stimulation of the PPN was proposed to treat levodopa-resistant gait disorders. However, the precise role of the cMRF in the pathophysiology of PD, particularly in freezing of gait and other non-motor symptoms is still not clear. Here, using micro electrode recording (MER) in 2 primates, we show that dopamine depletion did not alter the mean firing rate of the overall cMRF neurons, particularly the putative non-cholinergic ones, but only a decreased activity of the regular neurons sub-group (though to be the cholinergic PPN neurons). Interestingly, a significant increase in the relative proportion of cMRF neurons with a burst pattern discharge was observed after MPTP intoxication. The present results question the hypothesis of an over-inhibition of the CMRF by the basal ganglia output structures in PD. The decreased activity observed in the regular neurons could explain some non-motor symptoms in PD regarding the strong involvement of the cholinergic neurons on the modulation of the thalamo-cortical system. The increased burst activity under dopamine depletion confirms that this specific spike discharge pattern activity also observed in other basal ganglia nuclei and in different pathologies could play a mojor role in the pathophysiology of the disease and could explain several symptoms of PD including the freezing of gait. The present data will have to be replicated in a larger number of animals and will have to investigate more in details how the modification of the spike discharge of the cMRF neurons in the parkinsonian state could alter functions such as locomotion and attentional state. This will ultimely allow a better comprehension of the pathophysiology of freezing of gait.
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Avila-Luna A, Gálvez-Rosas A, Durand-Rivera A, Ramos-Languren LE, Ríos C, Arias-Montaño JA, Bueno-Nava A. Dopamine D 1 receptor activation maintains motor coordination and balance in rats. Metab Brain Dis 2018; 33:99-105. [PMID: 29052075 DOI: 10.1007/s11011-017-0126-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 10/09/2017] [Indexed: 10/18/2022]
Abstract
Dopamine (DA) modulates motor coordination, and its depletion, as in Parkinson's disease, produces motor impairment. The basal ganglia, cerebellum and cerebral cortex are interconnected, have functional roles in motor coordination, and possess dopamine D1 receptors (D1Rs), which are expressed at a particularly high density in the basal ganglia. In this study, we examined whether the activation of D1Rs modulates motor coordination and balance in the rat using a beam-walking test that has previously been used to detect motor coordination deficits. The systemic administration of the D1R agonist SKF-38393 at 2, 3, or 4 mg/kg did not alter the beam-walking scores, but the subsequent administration of the D1R antagonist SCH-23390 at 1 mg/kg did produce deficits in motor coordination, which were reversed by the full agonist SKF-82958. The co-administration of SKF-38393 and SCH-23390 did not alter the beam-walking scores compared with the control group, but significantly prevented the increase in beam-walking scores induced by SCH-23390. The effect of the D1R agonist to prevent and reverse the effect of the D1R antagonist in beam-walking scores is an indicator that the function of D1Rs is necessary to maintain motor coordination and balance in rats. Our results support that D1Rs mediate the SCH-23390-induced deficit in motor coordination.
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Affiliation(s)
- Alberto Avila-Luna
- División de Neurociencias, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, SSa, Calz México-Xochimilco 289, 14389, Ciudad de México, Mexico
| | - Arturo Gálvez-Rosas
- División de Neurociencias, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, SSa, Calz México-Xochimilco 289, 14389, Ciudad de México, Mexico
| | - Alfredo Durand-Rivera
- División de Neurociencias, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, SSa, Calz México-Xochimilco 289, 14389, Ciudad de México, Mexico
| | - Laura-Elisa Ramos-Languren
- Departamento de Neuroquímica, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, SSa, Insurgentes Sur 3877, 14269, Ciudad de México, Mexico
| | - Camilo Ríos
- Departamento de Neuroquímica, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, SSa, Insurgentes Sur 3877, 14269, Ciudad de México, Mexico
| | - José-Antonio Arias-Montaño
- Departamento de Fisiología, Biofísica y Neurociencias, Centro de Investigación y de Estudios Avanzados del IPN, Av. IPN 2508, 07360, Ciudad de México, Mexico
| | - Antonio Bueno-Nava
- División de Neurociencias, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, SSa, Calz México-Xochimilco 289, 14389, Ciudad de México, Mexico.
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Yoon SY, Lee SC, Kim NY, An YS, Kim YW. Brain metabolism in patients with freezing of gait after hypoxic-ischemic brain injury: A pilot study. Medicine (Baltimore) 2017; 96:e8212. [PMID: 29137009 PMCID: PMC5690702 DOI: 10.1097/md.0000000000008212] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Movement disorders are 1 of the long-term neurological complications that can occur after hypoxic-ischemic brain injury (HIBI). However, freezing of gait (FOG) after HIBI is rare. The aim of this study was to examine the brain metabolism of patients with FOG after HIBI using F-18 fluoro-2-deoxy-D-glucose positron emission tomography (F-18 FDG PET).We consecutively enrolled 11 patients with FOG after HIBI. The patients' overall brain metabolism was measured by F-18 FDG PET, and we compared their regional brain metabolic activity with that from 15 healthy controls using a voxel-by-voxel-based statistical mapping analysis. Additionally, we correlated each patient's FOG severity with the brain metabolism using a covariance analysis.Patients with FOG had significantly decreased brain glucose metabolism in the midbrain, bilateral thalamus, bilateral cingulate gyri, right supramarginal gyrus, right angular gyrus, right paracentral lobule, and left precentral gyrus (PFDR-corrected < .01, k = 50). No significant increases in brain metabolism were noted in patients with FOG. The covariance analysis identified significant correlations between the FOG severity and the brain metabolism in the right lingual gyrus, left fusiform gyrus, and bilateral cerebellar crus I (Puncorrected < 0.001, k = 50).Our data suggest that brain regions in the gait-related neural network, including the cerebral cortex, subcortical structures, brainstem, and cerebellum, may significantly contribute to the development of FOG in HIBI. Moreover, the FOG severity may be associated with the visual cortex and cerebellar regions.
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Affiliation(s)
- Seo Yeon Yoon
- Department of Rehabilitation Medicine, Bundang Jesaeng General Hospital, Gyeonggi-do
- Department of Medicine, Graduate Program, Yonsei University College of Medicine
| | - Sang Chul Lee
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul
| | - Na Young Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul
| | - Young-Sil An
- Department of Nuclear Medicine and Molecular Imaging, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Yong Wook Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul
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Kordys E, Apetz N, Schneider K, Duncan E, Büschbell B, Rohleder C, Sué M, Drzezga A, Neumaier B, Timmermann L, Endepols H. Motor impairment and compensation in a hemiparkinsonian rat model: correlation between dopamine depletion severity, cerebral metabolism and gait patterns. EJNMMI Res 2017; 7:68. [PMID: 28831764 PMCID: PMC5567589 DOI: 10.1186/s13550-017-0317-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 08/16/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND In Parkinson's disease (PD), cerebral dopamine depletion is associated with PD subtype-specific metabolic patterns of hypo- and hypermetabolism. It has been hypothesised that hypometabolism reflects impairment, while hypermetabolism may indicate compensatory activity. In order to associate metabolic patterns with pathophysiological and compensatory mechanisms, we combined resting state [18F]FDG-PET (to demonstrate brain metabolism in awake animals), [18F]FDOPA-PET (dopamine depletion severity) and gait analysis in a unilateral 6-hydroxydopamine rat model. RESULTS We found unilateral nigro-striatal dopaminergic loss to decrease swing speed of the contralesional forelimb and stride length of all paws in association with depletion severity. Depletion severity was found to correlate with compensatory changes such as increased stance time of the other three paws and diagonal weight shift to the ipsilesional hind paw. [18F]FDG-PET revealed ipsilesional hypo- and contralesional hypermetabolism; metabolic deactivation of the ipsilesional network needed for sensorimotor integration (hippocampus/retrosplenial cortex/lateral posterior thalamus) was solely associated with bradykinesia, but hypometabolism of the ipsilesional rostral forelimb area was related to both pathological and compensatory gait changes. Mixed effects were also found for hypermetabolism of the contralesional midbrain locomotor region, while contralesional striatal hyperactivation was linked to motor impairments rather than compensation. CONCLUSIONS Our results indicate that ipsilesional hypo- and contralesional hypermetabolism contribute to both motor impairment and compensation. This is the first time when energy metabolism, dopamine depletion and gait analysis were combined in a hemiparkinsonian model. By experimentally increasing or decreasing compensational brain activity, its potential and limits can be further investigated.
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Affiliation(s)
- Elena Kordys
- Institute of Radiochemistry and Experimental Molecular Imaging, University Hospital of Cologne, Kerpener Str. 62, 50937, Köln, Germany
| | - Nadine Apetz
- Institute of Radiochemistry and Experimental Molecular Imaging, University Hospital of Cologne, Kerpener Str. 62, 50937, Köln, Germany.,Department of Neurology, University Hospital of Cologne, Kerpener Str. 62, 50937, Köln, Germany
| | - Katharina Schneider
- Institute of Radiochemistry and Experimental Molecular Imaging, University Hospital of Cologne, Kerpener Str. 62, 50937, Köln, Germany
| | - Eilidh Duncan
- Institute of Radiochemistry and Experimental Molecular Imaging, University Hospital of Cologne, Kerpener Str. 62, 50937, Köln, Germany
| | - Beatriz Büschbell
- Institute of Radiochemistry and Experimental Molecular Imaging, University Hospital of Cologne, Kerpener Str. 62, 50937, Köln, Germany
| | - Cathrin Rohleder
- Institute of Radiochemistry and Experimental Molecular Imaging, University Hospital of Cologne, Kerpener Str. 62, 50937, Köln, Germany.,Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, J5, 68159, Mannheim, Germany
| | - Michael Sué
- Max-Planck Institute of Metabolism Research, Gleueler Str. 50, 50931, Köln, Germany
| | - Alexander Drzezga
- Department of Nuclear Medicine, University Hospital of Cologne, Kerpener Str. 62, 50937, Köln, Germany
| | - Bernd Neumaier
- Institute of Radiochemistry and Experimental Molecular Imaging, University Hospital of Cologne, Kerpener Str. 62, 50937, Köln, Germany.,Forschungszentrum Jülich GmbH, Institute for Neuroscience and Medicine, INM-5: Nuclear Chemistry, 52425, Jülich, Germany
| | - Lars Timmermann
- Department of Neurology, University Hospital of Cologne, Kerpener Str. 62, 50937, Köln, Germany
| | - Heike Endepols
- Institute of Radiochemistry and Experimental Molecular Imaging, University Hospital of Cologne, Kerpener Str. 62, 50937, Köln, Germany. .,Department of Nuclear Medicine, University Hospital of Cologne, Kerpener Str. 62, 50937, Köln, Germany.
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Cakmak YO, Apaydin H, Kiziltan G, Gündüz A, Ozsoy B, Olcer S, Urey H, Cakmak OO, Ozdemir YG, Ertan S. Rapid Alleviation of Parkinson's Disease Symptoms via Electrostimulation of Intrinsic Auricular Muscle Zones. Front Hum Neurosci 2017; 11:338. [PMID: 28701941 PMCID: PMC5487461 DOI: 10.3389/fnhum.2017.00338] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 06/12/2017] [Indexed: 11/13/2022] Open
Abstract
Background: Deep brain stimulation of the subthalamic nucleus (STN-DBS) and the pedunculopontine nucleus (PPN) significantly improve cardinal motor symptoms and postural instability and gait difficulty, respectively, in Parkinson's disease (PD). Objective and Hypothesis: Intrinsic auricular muscle zones (IAMZs) allow the potential to simultaneously stimulate the C2 spinal nerve, the trigeminal nerve, the facial nerve, and sympathetic and parasympathetic nerves in addition to providing muscle feedback and control areas including the STN, the PPN and mesencephalic locomotor regions. Our aim was to observe the clinical responses to IAMZ stimulation in PD patients. Method: Unilateral stimulation of an IAMZ, which includes muscle fibers for proprioception, the facial nerve, and C2, trigeminal and autonomic nerve fibers, at 130 Hz was performed in a placebo- and sham-controlled, double-blinded, within design, two-armed study of 24 PD patients. Results: The results of the first arm (10 patients) of the present study demonstrated a substantial improvement in Unified Parkinson's Disease Ratings Scale (UPDRS) motor scores due to 10 min of IAMZ electrostimulation (p = 0.0003, power: 0.99) compared to the placebo control (p = 0.130). A moderate to large clinical difference in the improvement in UPDRS motor scores was observed in the IAMZ electrostimulation group. The results of the second arm (14 patients) demonstrated significant improvements with dry needling (p = 0.011) and electrostimulation of the IAMZ (p < 0.001) but not with sham electrostimulation (p = 0.748). In addition, there was a significantly greater improvement in UPDRS motor scores in the IAMZ electrostimulation group compared to the IAMZ dry needling group (p < 0.001) and the sham electrostimulation (p < 0.001) groups. The improvement in UPDRS motor scores of the IAMZ electrostimulation group (ΔUPDRS = 5.29) reached moderate to high clinical significance, which was not the case for the dry needling group (ΔUPDRS = 1.54). In addition, both arms of the study demonstrated bilateral improvements in motor symptoms in response to unilateral IAMZ electrostimulation. Conclusion: The present study is the first demonstration of a potential role of IAMZ electrical stimulation in improving the clinical motor symptoms of PD patients in the short term.
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Affiliation(s)
- Yusuf O Cakmak
- Department of Anatomy, School of Medical Sciences, Otago UniversityDunedin, New Zealand
| | - Hülya Apaydin
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul UniversityIstanbul, Turkey
| | - Güneş Kiziltan
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul UniversityIstanbul, Turkey
| | - Ayşegül Gündüz
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul UniversityIstanbul, Turkey
| | - Burak Ozsoy
- Global Dynamic Systems (GDS) ARGE, Teknopark IstanbulIstanbul, Turkey
| | - Selim Olcer
- Department of Electrical Engineering, College of Engineering, Koç UniversityIstanbul, Turkey
| | - Hakan Urey
- Department of Electrical Engineering, College of Engineering, Koç UniversityIstanbul, Turkey
| | - Ozgur O Cakmak
- Department of Neurology, School of Medicine, Koç UniversityIstanbul, Turkey
| | - Yasemin G Ozdemir
- Department of Neurology, School of Medicine, Koç UniversityIstanbul, Turkey
| | - Sibel Ertan
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul UniversityIstanbul, Turkey
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Takakusaki K. Functional Neuroanatomy for Posture and Gait Control. J Mov Disord 2017; 10:1-17. [PMID: 28122432 PMCID: PMC5288669 DOI: 10.14802/jmd.16062] [Citation(s) in RCA: 460] [Impact Index Per Article: 65.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 12/15/2016] [Indexed: 01/09/2023] Open
Abstract
Here we argue functional neuroanatomy for posture-gait control. Multi-sensory information such as somatosensory, visual and vestibular sensation act on various areas of the brain so that adaptable posture-gait control can be achieved. Automatic process of gait, which is steady-state stepping movements associating with postural reflexes including headeye coordination accompanied by appropriate alignment of body segments and optimal level of postural muscle tone, is mediated by the descending pathways from the brainstem to the spinal cord. Particularly, reticulospinal pathways arising from the lateral part of the mesopontine tegmentum and spinal locomotor network contribute to this process. On the other hand, walking in unfamiliar circumstance requires cognitive process of postural control, which depends on knowledges of self-body, such as body schema and body motion in space. The cognitive information is produced at the temporoparietal association cortex, and is fundamental to sustention of vertical posture and construction of motor programs. The programs in the motor cortical areas run to execute anticipatory postural adjustment that is optimal for achievement of goal-directed movements. The basal ganglia and cerebellum may affect both the automatic and cognitive processes of posturegait control through reciprocal connections with the brainstem and cerebral cortex, respectively. Consequently, impairments in cognitive function by damages in the cerebral cortex, basal ganglia and cerebellum may disturb posture-gait control, resulting in falling.
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Affiliation(s)
- Kaoru Takakusaki
- The Research Center for Brain Function and Medical Engineering, Asahikawa Medical University, Asahikawa, Japan
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Caligiore D, Helmich RC, Hallett M, Moustafa AA, Timmermann L, Toni I, Baldassarre G. Parkinson's disease as a system-level disorder. NPJ PARKINSONS DISEASE 2016; 2:16025. [PMID: 28725705 PMCID: PMC5516580 DOI: 10.1038/npjparkd.2016.25] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 09/20/2016] [Accepted: 10/11/2016] [Indexed: 01/08/2023]
Abstract
Traditionally, the basal ganglia have been considered the main brain region implicated in Parkinson’s disease. This single area perspective gives a restricted clinical picture and limits therapeutic approaches because it ignores the influence of altered interactions between the basal ganglia and other cerebral components on Parkinsonian symptoms. In particular, the basal ganglia work closely in concert with cortex and cerebellum to support motor and cognitive functions. This article proposes a theoretical framework for understanding Parkinson’s disease as caused by the dysfunction of the entire basal ganglia–cortex–cerebellum system rather than by the basal ganglia in isolation. In particular, building on recent evidence, we propose that the three key symptoms of tremor, freezing, and impairments in action sequencing may be explained by considering partially overlapping neural circuits including basal ganglia, cortical and cerebellar areas. Studying the involvement of this system in Parkinson’s disease is a crucial step for devising innovative therapeutic approaches targeting it rather than only the basal ganglia. Possible future therapies based on this different view of the disease are discussed.
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Affiliation(s)
- Daniele Caligiore
- Laboratory of Computational Embodied Neuroscience (LOCEN), Istituto di Scienze e Tecnologie della Cognizione, Consiglio Nazionale delle Ricerche (ISTC-CNR), Roma, Italy
| | - Rick C Helmich
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, The Netherlands
| | - Mark Hallett
- National Institute of Neurological Disorders and Stroke (NINDS), Medical Neurology Branch, Bethesda, MD, USA
| | | | | | - Ivan Toni
- Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Gianluca Baldassarre
- Laboratory of Computational Embodied Neuroscience (LOCEN), Istituto di Scienze e Tecnologie della Cognizione, Consiglio Nazionale delle Ricerche (ISTC-CNR), Roma, Italy
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Attention modulation during motor preparation in Parkinsonian freezers: A time–frequency EEG study. Clin Neurophysiol 2016; 127:3506-3515. [DOI: 10.1016/j.clinph.2016.09.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 09/02/2016] [Accepted: 09/06/2016] [Indexed: 11/19/2022]
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Snijders AH, Takakusaki K, Debu B, Lozano AM, Krishna V, Fasano A, Aziz TZ, Papa SM, Factor SA, Hallett M. Physiology of freezing of gait. Ann Neurol 2016; 80:644-659. [DOI: 10.1002/ana.24778] [Citation(s) in RCA: 137] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 09/14/2016] [Accepted: 09/15/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Anke H. Snijders
- Department of Neurology, Donders Institute for Brain, Cognition, and Behavior; Radboud University Medical Center; Nijmegen the Netherlands
- Maasziekenhuis Pantein; Boxmeer the Netherlands
| | - Kaoru Takakusaki
- Research Center for Brain Function and Medical Engineering; Asahikawa Medical University; Asahikawa Japan
| | - Bettina Debu
- Joseph Fourier University, Grenoble Universities; Grenoble France
| | - Andres M. Lozano
- Division of Neurosurgery; University of Toronto; Toronto Ontario Canada
| | - Vibhor Krishna
- Division of Neurosurgery; University of Toronto; Toronto Ontario Canada
- Department of Neurosurgery; Ohio State University; Columbus OH
| | - Alfonso Fasano
- Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital; University Health Network; Toronto Ontario Canada
| | - Tipu Z. Aziz
- John Radcliffe Hospital; Headington Oxford United Kingdom
| | - Stella M. Papa
- Department of Neurology, Jean and Paul Amos Parkinson's Disease and Movement Disorders Center; Emory University School of Medicine; Atlanta GA
| | - Stewart A. Factor
- Department of Neurology, Jean and Paul Amos Parkinson's Disease and Movement Disorders Center; Emory University School of Medicine; Atlanta GA
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health; Bethesda MD
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Scott PJH, Shao X, Desmond TJ, Hockley BG, Sherman P, Quesada CA, Frey KA, Koeppe RA, Kilbourn MR, Bohnen NI. Investigation of Proposed Activity of Clarithromycin at GABAA Receptors Using [(11)C]Flumazenil PET. ACS Med Chem Lett 2016; 7:746-50. [PMID: 27563397 DOI: 10.1021/acsmedchemlett.5b00435] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 06/01/2016] [Indexed: 11/28/2022] Open
Abstract
Clarithromycin is a potential treatment for hypersomnia acting through proposed negative allosteric modulation of GABAA receptors. We were interested whether this therapeutic benefit might extend to Parkinson's disease (PD) patients because GABAergic neurotransmission is implicated in postural control. Prior to initiating clinical studies in PD patients, we wished to better understand clarithromycin's mechanism of action. In this work we investigated whether the proposed activity of clarithromycin at the GABAA receptor is associated with the benzodiazepine binding site using in vivo [(11)C]flumazenil positron emission tomography (PET) in primates and ex vivo [(3)H]flumazenil autoradiography in rat brain. While the studies demonstrate that clarithromycin does not change the K d of FMZ, nor does it competitively displace FMZ, there is preliminary evidence from the primate PET imaging studies that clarithromycin delays dissociation and washout of flumazenil from the primate brain in a dose-dependent fashion. These findings would be consistent with the proposed GABAA allosteric modulator function of clarithromycin. While the results are only preliminary, further investigation of the interaction of clarithromycin with GABA receptors and/or GABAergic medications is warranted, and therapeutic applications of clarithromycin alone or in combination with flumazenil, to treat hyper-GABAergic status in PD at minimally effective doses, should also be pursued.
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Affiliation(s)
- Peter J. H. Scott
- Division of Nuclear Medicine, Department of Radiology, The University of Michigan Medical School, Ann Arbor, Michigan 48109, United States
- The Interdepartmental Program in Medicinal Chemistry, The University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Xia Shao
- Division of Nuclear Medicine, Department of Radiology, The University of Michigan Medical School, Ann Arbor, Michigan 48109, United States
| | - Timothy J. Desmond
- Division of Nuclear Medicine, Department of Radiology, The University of Michigan Medical School, Ann Arbor, Michigan 48109, United States
| | - Brian G. Hockley
- Division of Nuclear Medicine, Department of Radiology, The University of Michigan Medical School, Ann Arbor, Michigan 48109, United States
| | - Phillip Sherman
- Division of Nuclear Medicine, Department of Radiology, The University of Michigan Medical School, Ann Arbor, Michigan 48109, United States
| | - Carole A. Quesada
- Division of Nuclear Medicine, Department of Radiology, The University of Michigan Medical School, Ann Arbor, Michigan 48109, United States
| | - Kirk A. Frey
- Division of Nuclear Medicine, Department of Radiology, The University of Michigan Medical School, Ann Arbor, Michigan 48109, United States
- Department
of Neurology, The University of Michigan Medical School, Ann Arbor, Michigan 48109, United States
| | - Robert A. Koeppe
- Division of Nuclear Medicine, Department of Radiology, The University of Michigan Medical School, Ann Arbor, Michigan 48109, United States
| | - Michael R. Kilbourn
- Division of Nuclear Medicine, Department of Radiology, The University of Michigan Medical School, Ann Arbor, Michigan 48109, United States
| | - Nicolaas I. Bohnen
- Division of Nuclear Medicine, Department of Radiology, The University of Michigan Medical School, Ann Arbor, Michigan 48109, United States
- Department
of Neurology, The University of Michigan Medical School, Ann Arbor, Michigan 48109, United States
- Neurology Service and Geriatrics Research,
Education, and Clinical Center, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan United States
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