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Jovanovic MZ, Stanojevic J, Stevanovic I, Ninkovic M, Ilic TV, Nedeljkovic N, Dragic M. Prolonged intermittent theta burst stimulation restores the balance between A2AR- and A1R-mediated adenosine signaling in the 6-hydroxidopamine model of Parkinson's disease. Neural Regen Res 2025; 20:2053-2067. [PMID: 39254566 DOI: 10.4103/nrr.nrr-d-23-01542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 06/17/2024] [Indexed: 09/11/2024] Open
Abstract
JOURNAL/nrgr/04.03/01300535-202507000-00027/figure1/v/2024-09-09T124005Z/r/image-tiff An imbalance in adenosine-mediated signaling, particularly the increased A2AR-mediated signaling, plays a role in the pathogenesis of Parkinson's disease. Existing therapeutic approaches fail to alter disease progression, demonstrating the need for novel approaches in PD. Repetitive transcranial magnetic stimulation is a non-invasive approach that has been shown to improve motor and non-motor symptoms of Parkinson's disease. However, the underlying mechanisms of the beneficial effects of repetitive transcranial magnetic stimulation remain unknown. The purpose of this study is to investigate the extent to which the beneficial effects of prolonged intermittent theta burst stimulation in the 6-hydroxydopamine model of experimental parkinsonism are based on modulation of adenosine-mediated signaling. Animals with unilateral 6-hydroxydopamine lesions underwent intermittent theta burst stimulation for 3 weeks and were tested for motor skills using the Rotarod test. Immunoblot, quantitative reverse transcription polymerase chain reaction, immunohistochemistry, and biochemical analysis of components of adenosine-mediated signaling were performed on the synaptosomal fraction of the lesioned caudate putamen. Prolonged intermittent theta burst stimulation improved motor symptoms in 6-hydroxydopamine-lesioned animals. A 6-hydroxydopamine lesion resulted in progressive loss of dopaminergic neurons in the caudate putamen. Treatment with intermittent theta burst stimulation began 7 days after the lesion, coinciding with the onset of motor symptoms. After treatment with prolonged intermittent theta burst stimulation, complete motor recovery was observed. This improvement was accompanied by downregulation of the eN/CD73-A2AR pathway and a return to physiological levels of A1R-adenosine deaminase 1 after 3 weeks of intermittent theta burst stimulation. Our results demonstrated that 6-hydroxydopamine-induced degeneration reduced the expression of A1R and elevated the expression of A2AR. Intermittent theta burst stimulation reversed these effects by restoring the abundances of A1R and A2AR to control levels. The shift in ARs expression likely restored the balance between dopamine-adenosine signaling, ultimately leading to the recovery of motor control.
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Affiliation(s)
- Milica Zeljkovic Jovanovic
- Laboratory for Neurobiology, Department of General Physiology and Biophysics, Faculty of Biology, University of Belgrade, Belgrade, Serbia
| | - Jelena Stanojevic
- Medical Faculty of Military Medical Academy, University of Defence, Belgrade, Serbia
| | - Ivana Stevanovic
- Medical Faculty of Military Medical Academy, University of Defence, Belgrade, Serbia
| | - Milica Ninkovic
- Medical Faculty of Military Medical Academy, University of Defence, Belgrade, Serbia
| | - Tihomir V Ilic
- Medical Faculty of Military Medical Academy, University of Defence, Belgrade, Serbia
| | - Nadezda Nedeljkovic
- Laboratory for Neurobiology, Department of General Physiology and Biophysics, Faculty of Biology, University of Belgrade, Belgrade, Serbia
| | - Milorad Dragic
- Laboratory for Neurobiology, Department of General Physiology and Biophysics, Faculty of Biology, University of Belgrade, Belgrade, Serbia
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Panda R, Deluisi JA, Lee TG, Davis S, Muñoz-Orozco I, Albin RL, Vesia M. Improving efficacy of repetitive transcranial magnetic stimulation for treatment of Parkinson disease gait disorders. Front Hum Neurosci 2024; 18:1445595. [PMID: 39253068 PMCID: PMC11381384 DOI: 10.3389/fnhum.2024.1445595] [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: 06/07/2024] [Accepted: 08/07/2024] [Indexed: 09/11/2024] Open
Abstract
Parkinson disease (PD) is a neurodegenerative disorder that causes motor and cognitive deficits, presenting complex challenges for therapeutic interventions. Repetitive transcranial magnetic stimulation (rTMS) is a type of neuromodulation that can produce plastic changes in neural activity. rTMS has been trialed as a therapy to treat motor and non-motor symptoms in persons with Parkinson disease (PwP), particularly treatment-refractory postural instability and gait difficulties such as Freezing of Gait (FoG), but clinical outcomes have been variable. We suggest improving rTMS neuromodulation therapy for balance and gait abnormalities in PwP by targeting brain regions in cognitive-motor control networks. rTMS studies in PwP often targeted motor targets such as the primary motor cortex (M1) or supplementary motor area (SMA), overlooking network interactions involved in posture-gait control disorders. We propose a shift in focus toward alternative stimulation targets in basal ganglia-cortex-cerebellum networks involved in posture-gait control, emphasizing the dorsolateral prefrontal cortex (dlPFC), cerebellum (CB), and posterior parietal cortex (PPC) as potential targets. rTMS might also be more effective if administered during behavioral tasks designed to activate posture-gait control networks during stimulation. Optimizing stimulation parameters such as dosage and frequency as used clinically for the treatment of depression may also be useful. A network-level perspective suggests new directions for exploring optimal rTMS targets and parameters to maximize neural plasticity to treat postural instabilities and gait difficulties in PwP.
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Affiliation(s)
- Rupsha Panda
- Department of Psychology, University of Michigan, Ann Arbor, MI, United States
| | - Joseph A Deluisi
- School of Kinesiology, University of Michigan, Ann Arbor, MI, United States
| | - Taraz G Lee
- Department of Psychology, University of Michigan, Ann Arbor, MI, United States
| | - Sheeba Davis
- School of Kinesiology, University of Michigan, Ann Arbor, MI, United States
| | | | - Roger L Albin
- Department of Neurology, University of Michigan, Ann Arbor, MI, United States
- Neurology Service & GRECC, VAAAHS, Ann Arbor, MI, United States
| | - Michael Vesia
- School of Kinesiology, University of Michigan, Ann Arbor, MI, United States
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Liu Z, Wen X, Xie X, Liu Y, Tan C, Kuang S, Liu H. The effects of transcranial magnetic stimulation for freezing of gait in Parkinson's disease: a systematic review and meta-analysis of randomized controlled trials. Front Aging Neurosci 2024; 16:1304852. [PMID: 38371401 PMCID: PMC10874105 DOI: 10.3389/fnagi.2024.1304852] [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: 09/30/2023] [Accepted: 01/18/2024] [Indexed: 02/20/2024] Open
Abstract
Background Freezing of gait (FOG) is one of the most disabling gait disturbances in Parkinson's disease (PD), affecting mobility and balance severely, thereby leading to an increased risk of falls. Objectives The purpose of this systematic review and meta-analysis was to investigate the effects of transcranial magnetic stimulation on FOG in PD. Methods Based on PRISMA guidelines, we searched the databases of MEDLINE (PubMed), Cochrane Library, PEDro, Embase, and Web of Science. Studies of the English language published up to July 2023 were searched. We retrieved for studies of randomized controlled trials (RCTs) of transcranial magnetic stimulation to treat FOG after PD and screened by inclusion and exclusion criteria. Risk of bias was assessed using the Cochrane Collaboration's tool (Revman5.30). Characteristics of RCTs were extracted. The heterogeneity of the trials was measured by I2 statistic. The effect size was expressed by a standardized mean difference (SMD) with a 95% confidence interval (CI). Results A total of 488 articles were screened, after screening sixteen RCTs involved in 408 patients were included in the qualitative analysis, and 15 RCTs were included in meta-analysis. The outcome measures included FOG-Q, walking time, TUG, and UPDRS. Six studies used FOG-Q as outcome measure, six studies used walking time, four studies used TUG, and six studies used UPDRS. Compared with placebo treatment, transcranial magnetic stimulation has positive significant effects in improving gait status with increased walking speed (SMD = -0.41, 95% CI = -0.75 to -0.06, I2 = 7% p = 0.02), FOG-Q scores (SMD = -0.55, 95% CI = -0.89 to -0.21, I2 = 29%, p = 0.002), UPDRS scores (SMD = -1.08, 95% CI = -1.39 to -0.78, I2 = 49%, P < 0.001) and the time of TUG (SMD = -0.56, 95% CI = -0.88 to -0.23, I2 = 25%, p = 0.02) decreased. Conclusion Transcranial magnetic stimulation could significantly improving gait conditions in PD patients with FOG. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/#recordDetails, CRD42023434286.
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Affiliation(s)
- Zicai Liu
- Department of Rehabilitation Medicine, Shaoguan First People’s Hospital, Shaoguan, Guangdong, China
| | - Xin Wen
- Department of Rehabilitation Medicine, Shaoguan First People’s Hospital, Shaoguan, Guangdong, China
| | - Xiuying Xie
- Department of Rehabilitation Medicine, Shaoguan First People’s Hospital, Shaoguan, Guangdong, China
| | - Yangyou Liu
- Department of Rehabilitation Medicine, Shaoguan First People’s Hospital, Shaoguan, Guangdong, China
| | - Cheng Tan
- Department of Rehabilitation Medicine, Shaoguan First People’s Hospital, Shaoguan, Guangdong, China
| | | | - Huiyu Liu
- Yuebei People’s Hospital, Shaoguan, Guangdong, China
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Wei YX, Tu LD, He L, Qiu YT, Su W, Zhang L, Ma RT, Gao Q. Research hotspots and trends of transcranial magnetic stimulation in Parkinson's disease: a bibliometric analysis. Front Neurosci 2023; 17:1280180. [PMID: 37928722 PMCID: PMC10620724 DOI: 10.3389/fnins.2023.1280180] [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: 08/19/2023] [Accepted: 10/05/2023] [Indexed: 11/07/2023] Open
Abstract
Background Transcranial magnetic stimulation (TMS), as a non-invasive neuromodulation technique, has been widely used in the treatment of Parkinson's disease (PD). The increasing application of TMS has promoted an increasing number of clinical studies. In this paper, a bibliometric analysis of existing studies was conducted to reveal current research hotspots and guide future research directions. Method Relevant articles and reviews were obtained from the Science Citation Index Expanded of Web of Science Core Collection database. Data related to publications, countries, institutions, authors, journals, citations, and keywords in the studies included in the review were systematically analyzed using VOSviewer 1.6.18 and Citespace 6.2.4 software. Result A total of 1,894 papers on the topic of TMS in PD between 1991 and 2022 were analyzed and visualized to identify research hotspots and trends in the field. The number of annual publications in this field of study has increased gradually over the past 30 years, with the number of annual publications peaking in 2022 (n = 150). In terms of publications and total citations, countries, institutions, and authors from North America and Western Europe were found to make significant contributions to the field. The current hotspot focuses on the effectiveness of TMS for PD in different stimulation modes or different stimulated brain regions. The keyword analysis indicates that the latest research is oriented to the mechanism study of TMS for motor symptoms in PD, and the non-motor symptoms are also receiving more attention. Conclusion Our study offers insights into the current hotspots and emerging trends of TMS in the rehabilitation of PD. These findings may serve as a guide for future research and the application of TMS for PD.
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Affiliation(s)
- Yi-Xin Wei
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Liang-Dan Tu
- Neurology Department, West China Hospital, Sichuan University, Chengdu, China
| | - Lin He
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Yi-Tong Qiu
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Wei Su
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Li Zhang
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Run-Ting Ma
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Qiang Gao
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
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Espinoza AI, Scholl JL, Singh A. TMS Bursts Can Modulate Local and Networks Oscillations During Lower-Limb Movement. J Clin Neurophysiol 2023; 40:371-377. [PMID: 34560704 DOI: 10.1097/wnp.0000000000000896] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Lower-limb motor functions involve processing information via both motor and cognitive control networks. Measuring oscillations is a key element in communication within and between cortical networks during high-order motor functions. Increased midfrontal theta oscillations are related to improved lower-limb motor performances in patients with movement disorders. Noninvasive neuromodulation approaches have not been explored extensively to understand the oscillatory mechanism of lower-limb motor functions. This study aims to examine the effects of repetitive transcranial magnetic stimulation on local and network EEG oscillations in healthy elderly subjects. METHODS Eleven healthy elderly subjects (67-73 years) were recruited via advertisements, and they underwent both active and sham stimulation procedures in a random, counterbalanced design. Transcranial magnetic stimulation bursts (θ-transcranial magnetic stimulation; 4 pulses/second) were applied over the midfrontal lead (vertex) before a GO-Cue pedaling task, and signals were analyzed using time-frequency methods. RESULTS Transcranial magnetic stimulation bursts increase the theta activity in the local ( p = 0.02) and the associated network during the lower-limb pedaling task ( p = 0.02). Furthermore, after task-related transcranial magnetic stimulation burst sessions, increased resting-state alpha activity was observed in the midfrontal region ( p = 0.01). CONCLUSIONS This study suggests the ability of midfrontal transcranial magnetic stimulation bursts to directly modulate local and network oscillations in a frequency manner during lower-limb motor task. Transcranial magnetic stimulation burst-induced modulation may provide insights into the functional roles of oscillatory activity during lower-limb movement in normal and disease conditions.
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Affiliation(s)
| | - Jamie L Scholl
- Center for Brain and Behavior Research, University of South Dakota, Vermillion, South Dakota, U.S.A. ; and
- Division of Basic Biomedical Sciences, Sanford School of Medicine, University of South Dakota, Vermillion, South Dakota, U.S.A
| | - Arun Singh
- Center for Brain and Behavior Research, University of South Dakota, Vermillion, South Dakota, U.S.A. ; and
- Division of Basic Biomedical Sciences, Sanford School of Medicine, University of South Dakota, Vermillion, South Dakota, U.S.A
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Zhu PA, Lu QQ, Li ZL, Hu RL, Xu S, Brodersen L, Liu YX, Liu H, Bao X. Efficacy of Tai Chi on lower limb function of Parkinson's disease patients: A systematic review and meta-analysis. Front Aging Neurosci 2023; 15:1096417. [PMID: 36819715 PMCID: PMC9929552 DOI: 10.3389/fnagi.2023.1096417] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 01/09/2023] [Indexed: 02/04/2023] Open
Abstract
Background At present, the effect of Tai Chi (TC) on lower limb function in patients with Parkinson's disease (PD) is controversial. Therefore, we conducted a meta-analysis on the influence of TC on lower limb function in PD patients. Methods According to the PRISMA guidelines, seven databases were searched. Randomized controlled trials (RCTS) were selected and screened according to inclusion and exclusion criteria. We assessed the quality of the studies using the Cochrane Risk of Bias tool and then extracted the characteristics of the included studies. The random effect model was adopted, and heterogeneity was measured by I 2 statistic. Results A total of 441 articles were screened, and 10 high-quality RCTs were with a total of 532 patients with PD met Our inclusion criteria. Meta-analysis showed that compared To control groups TC improved several outcomes. TC significantly improved motor function (SMD = -0.70; 95% CI = -0.95, -0.45; p < 0.001; I 2 = 35%), although The results were not statistically significant for The subgroup analysis of TC duration (SMD = -0.70; 95% CI = -0.95, -0.45; p = 0.88; I 2 = 0%;). TC significantly improved balance function (SMD = 0.89; 95% CI = 0.51, 1.27; p < 0.001; I 2 = 54%), functional walking capacity (SMD = -1.24; 95% CI = -2.40, -0.09; p = 0.04; I 2 = 95%), and gait velocity (SMD = 0.48; 95% CI = -0.02, 0.94; p = 0.04; I 2 = 78%), But Did Not improve endurance (SMD = 0.31; 95% CI = -0.12, 0.75; p = 0.16; I 2 = 0%), step length (SMD = 0.01; 95% CI = -0.34, 0.37; p = 0.94; I 2 = 29%), and cadence (SMD = 0.06; 95% CI = -0.25, 0.36; p = 0.70; I 2 = 0%). Conclusion TC has beneficial effects on motor function, balance function, functional walking ability, and gait velocity, but does not improve walking endurance, stride length, and cadence.
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Affiliation(s)
- Ping-an Zhu
- Department of Rehabilitation Medicine, Yuebei People’s Hospital, Shaoguan, China
| | - Qi-qi Lu
- Department of Rehabilitation Medicine, Yuebei People’s Hospital, Shaoguan, China
| | - Zhi-liang Li
- Department of Rehabilitation Medicine, Yuebei People’s Hospital, Shaoguan, China
| | - Rong-liang Hu
- Department of Rehabilitation Medicine, Jiangmen Central Hospital, Guangdong, Jiangmen, China
| | - Shu Xu
- Department of Rehabilitation Medicine, Shaoguan Railway Hospital, Shaoguan, China
| | - Lisa Brodersen
- Physical Therapy Program, Allen College, Waterloo, IA, United States
| | - Yuan-xin Liu
- College of Sports and Health Science, Xi’an Physical Education University, Xi’an, China,*Correspondence: Yuan-xin Liu,
| | - Howe Liu
- Physical Therapy Program, Allen College, Waterloo, IA, United States,Howe Liu,
| | - Xiao Bao
- Department of Rehabilitation Medicine, Yuebei People’s Hospital, Shaoguan, China,Xiao Bao,
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Zhou J, Chen Y, Gin T, Bao D, Zhou J. The effects of repetitive transcranial magnetic stimulation on standing balance and walking in older adults with age-related neurological disorders: a systematic review and meta-analysis. J Gerontol A Biol Sci Med Sci 2022; 78:842-852. [PMID: 35921153 PMCID: PMC10172986 DOI: 10.1093/gerona/glac158] [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: 04/06/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Considerable evidence showed that repetitive transcranial magnetic stimulation (rTMS) can improve standing balance and walking performance in older adults with age-related neurological disorders. We here thus completed a systematic review and meta-analysis to quantitatively examine such benefits of rTMS. METHODS A search strategy based on the PICOS principle was used to obtain the literature in four databases. The screening and assessments of quality and risk of bias in the included studies were independently completed by two researchers. Outcomes included scales related to standing balance, Timed Up and Go (TUG) time, and walking speed/time/distance. RESULTS Twenty-three studies consisting of 532 participants were included, and the meta-analysis was completed on 21 of these studies. The study quality was good. Compared to control, rTMS induced both short-term (≤3 days after last intervention session) and long-term (≥1 month following last intervention session) significant improvements in balance scales (e.g., Berg Balance Scale), TUG time, and walking speed/time/distance (short-term: standardized mean difference [SMD]=0.26~0.34, 95% confidence interval [CI]=0.05~0.62; long-term: SMD=0.40~0.44, 95% CI=0.04~0.79) for both PD and stroke cohorts. Subgroup analyses suggested that greater than nine sessions of high-frequency rTMS targeting primary motor cortex with greater than 3000 pulses per week can maximize such benefits. Only few mild-to-moderate adverse events/side effects were reported, which were similar between rTMS and control group. CONCLUSION The results suggest that rTMS holds promise to improve balance and walking performance in older adults with age-related neurological disorders. Future studies with more rigorous design are needed to confirm the observations in this work.
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Affiliation(s)
- Jun Zhou
- China Athletics College, Beijing Sport University, Beijing, China
| | - Yan Chen
- Sports Coaching College, Beijing Sport University, Beijing, China
| | - Trenton Gin
- Cornell University, Ithaca, New York, NY, United States
| | - Dapeng Bao
- China Institute of Sport and Health Science, Beijing Sport University, Beijing, China
| | - Junhong Zhou
- Hebrew SeniorLife Hinda and Arthur Marcus Institute for Aging Research, Harvard Medical School, Boston, MA, United States
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Guo Y, Yang J, Liu Y, Chen X, Yang GZ. Detection and assessment of Parkinson's disease based on gait analysis: A survey. Front Aging Neurosci 2022; 14:916971. [PMID: 35992585 PMCID: PMC9382193 DOI: 10.3389/fnagi.2022.916971] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 07/08/2022] [Indexed: 11/13/2022] Open
Abstract
Neurological disorders represent one of the leading causes of disability and mortality in the world. Parkinson's Disease (PD), for example, affecting millions of people worldwide is often manifested as impaired posture and gait. These impairments have been used as a clinical sign for the early detection of PD, as well as an objective index for pervasive monitoring of the PD patients in daily life. This review presents the evidence that demonstrates the relationship between human gait and PD, and illustrates the role of different gait analysis systems based on vision or wearable sensors. It also provides a comprehensive overview of the available automatic recognition systems for the detection and management of PD. The intervening measures for improving gait performance are summarized, in which the smart devices for gait intervention are emphasized. Finally, this review highlights some of the new opportunities in detecting, monitoring, and treating of PD based on gait, which could facilitate the development of objective gait-based biomarkers for personalized support and treatment of PD.
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Affiliation(s)
- Yao Guo
- Institute of Medical Robotics, Shanghai Jiao Tong University, Shanghai, China
| | - Jianxin Yang
- Institute of Medical Robotics, Shanghai Jiao Tong University, Shanghai, China
| | - Yuxuan Liu
- Institute of Medical Robotics, Shanghai Jiao Tong University, Shanghai, China
| | - Xun Chen
- Department of Electronic Engineering and Information Science, University of Science and Technology of China, Hefei, China
| | - Guang-Zhong Yang
- Institute of Medical Robotics, Shanghai Jiao Tong University, Shanghai, China
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Deng S, Dong Z, Pan L, Liu Y, Ye Z, Qin L, Liu Q, Qin C. Effects of repetitive transcranial magnetic stimulation on gait disorders and cognitive dysfunction in Parkinson's disease: A systematic review with meta-analysis. Brain Behav 2022; 12:e2697. [PMID: 35862217 PMCID: PMC9392523 DOI: 10.1002/brb3.2697] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/22/2022] [Accepted: 06/23/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) is acknowledged to be crucial to manage freezing of gait (FOG) and cognitive impairment for patients with Parkinson's disease (PD), but its effectiveness is unclear. OBJECTIVE To determine the effects of rTMS on FOG and cognitive function in people with PD and to investigate potential factors that modulate the rTMS effects. METHODS Databases searched included PubMed, Web of Science, EMBASE, and the Cochrane Library from inception to December 31, 2021. Eligible studies include a controlled randomized clinical trial of rTMS intervention for FOG and cognitive dysfunction in PD patients. The weighted mean difference (WMD) with 95% confidence intervals (CI) were calculated with fixed-effects models. The outcome of the study included gait and cognitive assessments. RESULTS Sixteen studies with a total of 419 patients were included. Fixed-effects analysis revealed that rTMS was effective in improving freezing of gait questionnaire scores (short-term effect: WMD = -0.925, 95% CI: -1.642 to -0.209, p = .011; long-term effect: WMD = -2.120, 95% CI: -2.751 to -1.489, p = .000), 10-m walking time (short-term effect: WMD = -0.456, 95% CI: -0.793 to -0.119, p = .008; long-term effect: WMD = -0.526, 95% CI: -0.885 to -0.167, p = .004), Timed Up-and-Go scores (short-term effect: WMD = -1.064, 95% CI: -1.555 to -0.572, p = .000; long-term effect: WMD = -1.097, 95% CI: -1.422 to -0.772, p = .000), Montreal cognitive assessment (WMD = 3.714, 95% CI: 2.567 to 4.861, p = .000), and frontal assessment battery (WMD = -0.584, 95% CI: -0.934 to -0.234, p = .001). CONCLUSIONS RTMS showed a beneficial effect on FOG and cognitive dysfunction in parkinsonism. However, the optimal rTMS protocol has not been determined and further high-quality studies are needed.
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Affiliation(s)
- Shan Deng
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Zhimei Dong
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Liya Pan
- Department of Neurology, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, China
| | - Ying Liu
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Ziming Ye
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Lu Qin
- Department of Neurology, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, China
| | - Qianqian Liu
- Department of Neurology, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, China
| | - Chao Qin
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
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Krogh S, Jønsson AB, Aagaard P, Kasch H. Efficacy of repetitive transcranial magnetic stimulation for improving lower limb function in individuals with neurological disorders: A systematic review and meta-analysis of randomized sham-controlled trials. J Rehabil Med 2022; 54:jrm00256. [PMID: 34913062 PMCID: PMC8862648 DOI: 10.2340/jrm.v53.1097] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2021] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE To determine the efficacy of repetitive transcranial magnetic stimulation vs sham stimulation on improving lower-limb functional outcomes in individuals with neurological disorders. DATA SOURCES PubMed, CINAHL, Embase and Scopus databases were searched from inception to 31 March 2020 to identify papers (n = 1,198). Two researchers independently reviewed studies for eligibility. Randomized clinical trials with parallel-group design, involving individuals with neurological disorders, including lower-limb functional outcome measures and published in scientific peer-reviewed journals were included. DATA EXTRACTION Two researchers independently screened eligible papers (n = 27) for study design, clinical population characteristics, stimulation protocol and relevant outcome measures, and assessed study quality. DATA SYNTHESIS Studies presented a moderate risk of selection, attrition and reporting bias. An overall effect of repetitive transcranial magnetic stimulation was found for outcomes: gait (effect size [95% confidence interval; 95% CI]: 0.51 [0.29; 0.74], p = 0.003) and muscle strength (0.99 [0.40; 1.58], p = 0.001) and disorders: stroke (0.20 [0.00; 0.39], p = 0.05), Parkinson's disease (1.01 [0.65; 1.37], p = 0.02) and spinal cord injury (0.50 [0.14; 0.85], p = 0.006), compared with sham. No effect was found for outcomes: mobility and balance. CONCLUSION Supplementary repetitive transcranial magnetic stimulation may promote rehabilitation focused on ambulation and muscle strength and overall lower-limb functional recovery in individuals with stroke, Parkinson's disease and spinal cord injury. Further evidence is needed to extrapolate these findings.
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Affiliation(s)
- Søren Krogh
- Department of Neurology, Regional Hospital Viborg, Department of Clinical Medicine, Aarhus University, Denmark.
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Cheng B, Zhu T, Zhao W, Sun L, Shen Y, Xiao W, Zhang S. Effect of Theta Burst Stimulation-Patterned rTMS on Motor and Nonmotor Dysfunction of Parkinson's Disease: A Systematic Review and Metaanalysis. Front Neurol 2022; 12:762100. [PMID: 35095722 PMCID: PMC8790062 DOI: 10.3389/fneur.2021.762100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 12/10/2021] [Indexed: 01/27/2023] Open
Abstract
Background: Theta burst stimulation (TBS), a type of patterned repetitive transcranial magnetic stimulation (rTMS), has several advantages, such as short time of single treatment and low stimulation intensity compared with traditional rTMS. Since the efficacy of TBS on the symptoms of Parkinson's disease (PD) was inconsistent among different studies, we systematically searched these studies and quantitatively analyzed the therapeutic effect of TBS for patients with PD. Methods: We followed the recommended PRISMA guidelines for systematic reviews. Studies from PubMed, EMBASE, CENTRAL, and ClinicalTrials.gov from January 1, 2005 of each database to September 30, 2021 were analyzed. We also manually retrieved studies of reference. Results: Eight eligible studies with 189 participants (received real TBS and/or sham TBS) were included. This metaanalysis found that TBS did not significantly improve Unified Parkinson's Disease Rating Scale part III (UPDRS-III) score in the “on” medicine state (SMD = −0.06; 95% CI, −0.37 to 0.25; p = 0.69; I2 = 0%), while, it brought significant improvement of UPDRS-III scores in the “off” medicine state (SMD = −0.37; 95% CI, −0.65 to −0.09; p < 0.01; I2 = 19%). Subgroup analysis found that merely continuous TBS (cTBS) over the supplementary motor area (SMA) brought significant improvement of UPDRS-III score (SMD = −0.63; 95% CI, −1.02 to −0.25; p < 0.01). TBS had insignificant effectiveness for upper limb movement disorder both in the “on” and “off” medicine status (SMD = −0.07; 95% CI, −0.36 to 0.22; p = 0.64; I2 = 0%; SMD = −0.21; 95% CI, −0.57 to 0.15; p = 0.26; I2 = 0%; respectively). TBS significantly improved slowing of gait in the “off” medicine status (SMD = −0.37; 95% CI, −0.71 to −0.03; p = 0.03; I2 = 0%). Subgroup analysis suggested that only intermittent TBS (iTBS) over the primary motor cortex (M1) + dorsolateral prefrontal cortex (DLPFC) had significant difference (SMD = −0.57; 95% CI, −1.13 to −0.01; p = 0.04). Additionally, iTBS over the M1+ DLPFC had a short-term (within 2 weeks) therapeutic effect on PD depression (MD = −2.93; 95% CI, −5.52 to −0.33; p = 0.03). Conclusion: Our study demonstrated that cTBS over the SMA could significantly improve the UPDRS-III score for PD patients in the “off,” not in the “on,” medicine state. TBS could not bring significant improvement of upper limb movement dysfunction. ITBS over the M1+DLPFC could significantly improve the slowing of gait in the “off” medicine status. Additionally, iTBS over the M1+DLPFC has a short-term (within 2 weeks) therapeutic effect on PD depression. Further RCTs of a large sample, and excellent design are needed to confirm our conclusions.
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Affiliation(s)
- Bo Cheng
- Department of Neurology, Affiliated Hospital of Medical College, North Sichuan Medical College (University), Nanchong, China
| | - Tao Zhu
- Department of Preventive Medicine, North Sichuan Medical College (University), Nanchong, China
| | - Wenhao Zhao
- Department of Neurology, Affiliated Hospital of Medical College, North Sichuan Medical College (University), Nanchong, China
| | - Ling Sun
- Department of Neurology, Affiliated Hospital of Medical College, North Sichuan Medical College (University), Nanchong, China
| | - Yao Shen
- Department of Neurology, Affiliated Hospital of Medical College, North Sichuan Medical College (University), Nanchong, China
| | - Wei Xiao
- Department of Neurology, Affiliated Hospital of Medical College, North Sichuan Medical College (University), Nanchong, China
| | - Shushan Zhang
- Department of Neurology, Affiliated Hospital of Medical College, North Sichuan Medical College (University), Nanchong, China
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12
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Cui CK, Lewis SJG. Future Therapeutic Strategies for Freezing of Gait in Parkinson's Disease. Front Hum Neurosci 2021; 15:741918. [PMID: 34795568 PMCID: PMC8592896 DOI: 10.3389/fnhum.2021.741918] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 10/05/2021] [Indexed: 12/28/2022] Open
Abstract
Freezing of gait (FOG) is a common and challenging clinical symptom in Parkinson’s disease. In this review, we summarise the recent insights into freezing of gait and highlight the strategies that should be considered to improve future treatment. There is a need to develop individualised and on-demand therapies, through improved detection and wearable technologies. Whilst there already exist a number of pharmacological (e.g., dopaminergic and beyond dopamine), non-pharmacological (physiotherapy and cueing, cognitive training, and non-invasive brain stimulation) and surgical approaches to freezing (i.e., dual-site deep brain stimulation, closed-loop programming), an integrated collaborative approach to future research in this complex area will be necessary to systematically investigate new therapeutic avenues. A review of the literature suggests standardising how gait freezing is measured, enriching patient cohorts for preventative studies, and harnessing the power of existing data, could help lead to more effective treatments for freezing of gait and offer relief to many patients.
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Affiliation(s)
- Cathy K Cui
- ForeFront Parkinson's Disease Research Clinic, Brain and Mind Centre, School of Medical Sciences, The University of Sydney, Camperdown, NSW, Australia
| | - Simon J G Lewis
- ForeFront Parkinson's Disease Research Clinic, Brain and Mind Centre, School of Medical Sciences, The University of Sydney, Camperdown, NSW, Australia
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13
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Cury RG, Moro E. New developments for spinal cord stimulation. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2021; 159:129-151. [PMID: 34446244 DOI: 10.1016/bs.irn.2021.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Spinal cord stimulation (SCS) is a well-established therapy for the treatment of chronic neuropathic pain. Newer SCS waveforms have improved patient outcomes, leading to its increased utilization among many pain conditions. More recently, SCS has been used to treat some symptoms in several movement disorders because of its good profile tolerability and capacity to stimulate local and distant areas of the central nervous system. After the original experimental findings in animal models of Parkinson's disease (PD) in the late 2000s, several studies have reported the beneficial clinical effects of SCS stimulation on gait in PD patients. Additionally, the spinal cord has emerged as a potential therapeutic target to treat essential and orthostatic tremor, some forms of ataxia, and atypical parkinsonisms. In this chapter, we describe the most recent advances in SCS for pain and the rationale and potential mechanism of action of stimulating the spinal cord for treating movement disorders, focusing on its network modulation. We also summarize the main clinical studies performed to date as well as their limitations and future perspectives.
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Affiliation(s)
- Rubens Gisbert Cury
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil.
| | - Elena Moro
- Movement Disorders Unit, Division of Neurology, CHU of Grenoble, Grenoble Alpes University, Grenoble, France; INSERM U1216, Grenoble Institute of Neurosciences, Grenoble, France
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14
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Pang MY. Physiotherapy management of Parkinson's disease. J Physiother 2021; 67:163-176. [PMID: 34154949 DOI: 10.1016/j.jphys.2021.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 05/03/2021] [Accepted: 06/07/2021] [Indexed: 02/07/2023] Open
Affiliation(s)
- Marco Yc Pang
- Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong.
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15
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Cleary RT, Bucholz R. Neuromodulation Approaches in Parkinson's Disease Using Deep Brain Stimulation and Transcranial Magnetic Stimulation. J Geriatr Psychiatry Neurol 2021; 34:301-309. [PMID: 34219521 DOI: 10.1177/08919887211018269] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Parkinson's Disease (PD) is the second most common neurodegenerative disease, characterized by progressive motor (such as resting tremor, hypokinesia, postural instability) and non-motor symptoms (such as neuropsychiatric decline and autonomic dysfunction). Since its introduction in the late 1980s, deep brain stimulation (DBS) has revolutionized the treatment of PD. Initially used in patients' with advanced PD with either medically refractory motor symptoms or medication intolerance, DBS typically provides excellent improvement in motor symptoms. Indications for DBS have continued to expand, with demonstrated efficacy in early PD and essential tremor, and promising preliminary results in the treatment of epilepsy, psychiatric disease, and depression. Advancements in DBS hardware, programming, neuroimaging, and surgical techniques have led to progressive improvement in efficacy and safety profiles. Thanks to ongoing research into remote programming, adaptive DBS, new targets, and alternative interventions, such as transcranial magnetic stimulation, the opportunities for further improvements in DBS and neuromodulation are bright.
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Affiliation(s)
- Ryan T Cleary
- Department of Neurosurgery, 25213Saint Louis University Hospital, Saint Louis, MO, USA
| | - Richard Bucholz
- Department of Neurosurgery, 25213Saint Louis University Hospital, Saint Louis, MO, USA
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16
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Karateev AE, Lila AM, Vertkin AL, Alekseeva LI, Gerasimenko MY, Arkov VV, Smirnova SN, Sukhareva ML, Tsykunov MB. Efficiency and safety of magnetotherapy in the treatment of osteoarthritis. Expert council (3 june 2020, Moscow). RHEUMATOLOGY SCIENCE AND PRACTICE 2021. [DOI: 10.47360/1995-4484-2020-734-742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
| | - A. M. Lila
- V.A. Nasonova Research Institute of Rheumatology; Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of the Russian Federation
| | - A. L. Vertkin
- A.I. Yevdokimov Moscow State University of Medicine and Dentistry
| | | | - M. Yu. Gerasimenko
- Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of the Russian Federation
| | - V. V. Arkov
- Moscow Centre for Research and Practice in Medical Rehabilitation, Restorative and Sports Medicine of Moscow Healthcare Department
| | - S. N. Smirnova
- Moscow Regional Research and Clinical Institute (“MONIKI”)
| | | | - M. B. Tsykunov
- N.N. Priorov Central Research Institute of Traumatology and Orthopedics; N.I. Pirogov Russian National Research Medical University
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17
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Transcranial magnetic stimulation and gait disturbances in Parkinson's disease: A systematic review. Neurophysiol Clin 2020; 50:213-225. [DOI: 10.1016/j.neucli.2020.05.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 05/14/2020] [Accepted: 05/14/2020] [Indexed: 12/11/2022] Open
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18
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Cury RG, Carra R, Reis J, Barbosa ER. Optimizing Noninvasive Stimulation to Treat Gait Problems in Parkinson Disease. Arch Phys Med Rehabil 2020; 101:1097-1098. [PMID: 32044041 DOI: 10.1016/j.apmr.2019.10.198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 10/02/2019] [Indexed: 10/25/2022]
Affiliation(s)
| | - Rafael Carra
- Movement Disorders Unit, University of São Paulo, São Paulo, Brazil
| | - Janaína Reis
- Movement Disorders Unit, University of São Paulo, São Paulo, Brazil
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