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Quek DYL, Economou K, MacDougall H, Lewis SJG, Ehgoetz Martens KA. Validating a Seated Virtual Reality Threat Paradigm for Inducing Anxiety and Freezing of Gait in Parkinson's Disease. JOURNAL OF PARKINSONS DISEASE 2021; 11:1443-1454. [PMID: 34057098 DOI: 10.3233/jpd-212619] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Although prior research has established that freezing of gait (FOG) in Parkinson's disease (PD) is associated with anxiety, only one study to date has directly manipulated anxiety levels to induce FOG. OBJECTIVE The current study aimed to replicate these previous findings and evaluate whether a seated version of a 'threat' virtual reality (VR) paradigm could induce anxiety and provoke FOG. METHODS Twenty-four PD patients with FOG were assessed across various threat conditions in both a walking VR paradigm (Experiment 1) and a seated VR paradigm (Experiment 2). Both paradigms manipulated the height (i.e., elevated vs ground) and width (wide vs narrow) of the planks participants were instructed to walk across. RESULTS Across both experiments, the Elevated + Narrow condition provoked significantly greater number of freezing episodes compared to all other conditions. Higher levels of self-reported anxiety were reported during the Elevated+Narrow condition compared to all other conditions in Experiment 1, and compared to the Ground condition in Experiment 2. CONCLUSION These findings confirm that anxiety contributes to FOG and validates the use of a seated VR threat paradigm for provoking anxiety-related freezing. This enables future studies to combine this paradigm with functional MRI to explore the neural correlates underlying the role of anxiety in FOG.
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Affiliation(s)
- Dione Y L Quek
- ForeFront Parkinson's Disease Research Clinic, Brain and Mind Centre, School of Medical Sciences, University of Sydney, Australia
| | - Kristin Economou
- ForeFront Parkinson's Disease Research Clinic, Brain and Mind Centre, School of Medical Sciences, University of Sydney, Australia
| | | | - Simon J G Lewis
- ForeFront Parkinson's Disease Research Clinic, Brain and Mind Centre, School of Medical Sciences, University of Sydney, Australia
| | - Kaylena A Ehgoetz Martens
- ForeFront Parkinson's Disease Research Clinic, Brain and Mind Centre, School of Medical Sciences, University of Sydney, Australia.,Department of Kinesiology, University of Waterloo, Canada
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Salari M, Lang AE, Dargahi L, Habibi AH, Etemadifar M. Irreversible extreme freezing of gait after dopamine agonist withdrawal. Clin Case Rep 2021; 9:e04712. [PMID: 34466262 PMCID: PMC8385461 DOI: 10.1002/ccr3.4712] [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: 06/08/2021] [Revised: 07/21/2021] [Accepted: 07/30/2021] [Indexed: 12/03/2022] Open
Abstract
Dopamine agonist withdrawal can cause freezing of gait in PD patients.
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Affiliation(s)
- Mehri Salari
- Functional Neurosurgery Research CenterShohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical SciencesTehranIran
| | - Anthony E. Lang
- Edmond J. Safra Program for Parkinson Disease and the Morton and Gloria Shulman Movement Disorders Clinic,Toronto Western HospitalUniversity Health NetworkTorontoONCanada
- Krembil Brain Institute TorontoTorontoONCanada
| | - Leila Dargahi
- Neuroscience Research Center, Shahid Beheshti University of Medical SciencesTehranIran
| | | | - Masoud Etemadifar
- Department of NeurosurgeryIsfahan University of Medical SciencesIsfahanIran
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Gait variability is linked to the atrophy of the Nucleus Basalis of Meynert and is resistant to STN DBS in Parkinson's disease. Neurobiol Dis 2020; 146:105134. [PMID: 33045357 PMCID: PMC7711311 DOI: 10.1016/j.nbd.2020.105134] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/26/2020] [Accepted: 10/06/2020] [Indexed: 12/11/2022] Open
Abstract
Parkinson’s disease (PD) is a systemic brain disorder where the cortical cholinergic network begins to degenerate early in the disease process. Readily accessible, quantitative, and specific behavioral markers of the cortical cholinergic network are lacking. Although degeneration of the dopaminergic network may be responsible for deficits in cardinal motor signs, the control of gait is a complex process and control of higher-order aspects of gait, such as gait variability, may be influenced by cognitive processes attributed to cholinergic networks. We investigated whether swing time variability, a metric of gait variability that is independent from gait speed, was a quantitative behavioral marker of cortical cholinergic network integrity in PD. Twenty-two individuals with PD and subthalamic nucleus (STN) deep brain stimulation (PD-DBS cohort) and twenty-nine age-matched controls performed a validated stepping-in-place (SIP) task to assess swing time variability off all therapy. The PD-DBS cohort underwent structural MRI scans to measure gray matter volume of the Nucleus Basalis of Meynert (NBM), the key node in the cortical cholinergic network. In order to determine the role of the dopaminergic system on swing time variability, it was measured ON and OFF STN DBS in the PD-DBS cohort, and on and off dopaminergic medication in a second PD cohort of thirty-two individuals (PD-med). A subset of eleven individuals in the PD-DBS cohort completed the SIP task again off all therapy after three years of continuous DBS to assess progression of gait impairment. Swing time variability was significantly greater (i.e., worse) in PD compared to controls and greater swing time variability was related to greater atrophy of the NBM, as was gait speed. STN DBS significantly improved cardinal motor signs and gait speed but did not improve swing time variability, which was replicated in the second cohort using dopaminergic medication. Swing time variability continued to worsen in PD, off therapy, after three years of continuous STN DBS, and NBM atrophy showed a trend for predicting the degree of increase. In contrast, cardinal motor signs did not progress. These results demonstrate that swing time variability is a reliable marker of cortical cholinergic health, and support a framework in which higher-order aspects of gait control in PD are reliant on the cortical cholinergic system, in contrast to other motor aspects of PD that rely on the dopaminergic network.
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Kosutzka Z, Kusnirova A, Hajduk M, Straka I, Minar M, Valkovic P. Gait Disorders Questionnaire-Promising Tool for Virtual Reality Designing in Patients With Parkinson's Disease. Front Neurol 2019; 10:1024. [PMID: 31611840 PMCID: PMC6768968 DOI: 10.3389/fneur.2019.01024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 09/09/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Gait disorders (GD) are frequent and disabling symptoms in patients with Parkinson's disease, mostly because they significantly limit mobility and often lead to fear of falls or actual falls. Nowadays, rehabilitation is considered to be the most effective nonpharmacological approach to reduce risk of falls. Using paradigms in virtual reality (VR) is a promising tool in neurorehabilitation because of the potential improvement in motor learning and improvement in daily functioning by replicating everyday real-life scenarios. Objective: To identify the most prevalent everyday situations which impair gait in PD that could be simulated in virtual reality (VR) environment. Methods: A newly developed self-report questionnaire consisting of 15 binary response items (YES/NO) encompassing everyday walking situations was administered to 62 patients diagnosed with idiopathic PD according to MDS Clinical Diagnostic Criteria. We included patients able to walk unassisted for at least 10 min and without significant cognitive impairment. Mokken Scale Analysis was used to evaluate psychometric properties of the scale. Results: Questionnaires from 58 patients were analyzed (31 men, age = 63 ± 9.9 y, disease duration = 7.02 ± 4.03 y, LEDD = 1115 ± 549.4 mg, H&Y = 2.4 ± 0.6). Only 10 items (out of 15) were identified as scalable and these were included in Gait Disorders Questionnaire (GDQ). The most prevalent trigger of gait disorders was walking under time pressure, followed by gait in crowded places and walking while dual-tasking. The total score of GDQ significantly correlated with the disease duration (r s = 0.347, p = 0.008) and modified H&Y staging (r s = 0.288, p = 0.028). Conclusion: With the use of GDQ we identified the most prevalent everyday transition activities that provoke gait disorders in patients with PD. The results may be useful for further development and systematic application of VR paradigms for physiotherapy of PD patients.
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Affiliation(s)
- Zuzana Kosutzka
- 2nd Department of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Alice Kusnirova
- 2nd Department of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Michal Hajduk
- Department of Psychology, Faculty of Arts, Comenius University, Bratislava, Slovakia.,Department of Psychiatry, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Igor Straka
- 2nd Department of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Michal Minar
- 2nd Department of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Peter Valkovic
- 2nd Department of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovakia.,Centre of Experimental Medicine, Institute of Normal and Pathological Physiology, Slovak Academy of Sciences, Bratislava, Slovakia
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Cortical afferent inhibition abnormalities reveal cholinergic dysfunction in Parkinson’s disease: a reappraisal. J Neural Transm (Vienna) 2017; 124:1417-1429. [DOI: 10.1007/s00702-017-1775-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 07/31/2017] [Indexed: 12/14/2022]
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Zhang LL, Canning SD, Wang XP. Freezing of Gait in Parkinsonism and its Potential Drug Treatment. Curr Neuropharmacol 2016; 14:302-6. [PMID: 26635194 PMCID: PMC4876585 DOI: 10.2174/1570159x14666151201190040] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 07/16/2015] [Accepted: 10/09/2015] [Indexed: 11/22/2022] Open
Abstract
Freezing of gait (FOG) is a heterogeneous symptom. Studies of treatment for FOG are scarce. Levodopa and monoamine oxidase inhibitors (rasagiline and selegiline) have shown effective improvement for FOG. Other drugs, such as L-threo-3, 4-dihydroxyphenylserine, amantadine, and botulinum toxin have exhibited some beneficial effects. The present review summarizes the potential drug treatment for FOG in Parkinsonism.
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Affiliation(s)
| | | | - Xiao-Ping Wang
- Department of Neurology, Shanghai First People's Hospital, Shanghai Jiao-Tong University, China. 200080.
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Yoon SY, Lee SC, Kim YW. Spatiotemporal Characteristics of Freezing of Gait in Patients After Hypoxic-Ischemic Brain Injury: A Pilot Study. Medicine (Baltimore) 2016; 95:e3666. [PMID: 27175696 PMCID: PMC4902538 DOI: 10.1097/md.0000000000003666] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The objective of this study was to investigate spatiotemporal characteristics with gait variability in patients with freezing of gait (FOG) after hypoxic-ischemic brain injury (HIBI).Eleven patients showing FOG after HIBI and 15 normal controls were consecutively enrolled. We performed gait analysis using a computerized gait system (VICON MX-T10 Motion Analysis System) and compared spatiotemporal characteristics and gait variability in both groups. Additionally, we performed correlation analysis to identify the gait parameters associated with severity of freezing, which we measured based on unified Parkinson disease Rating Scale subscore.Spatiotemporal characteristic of FOG patients showed increased stance time and double support phase and decreased swing time, single support phase, stride length, step length, and gait velocity compared with normal controls (P < 0.05). Besides baseline spatiotemporal characteristics, step time asymmetry and step length asymmetry were significantly increased in HIBI patients with FOG (P < 0.05). The coefficient of variation, which reflects the variability of each parameter, demonstrated increased cadence, stride time, swing time, single support phase, stride length, step length, and gait velocity variability in HIBI patients with FOG compared with normal controls (P < 0.05). Correlation analysis between FOG severity and spatiotemporal parameters revealed gait velocity, step length, and single support phase to be spatiotemporal parameters related to FOG severity (P < 0.05).Our findings suggest that bilateral gait coordination deterioration plays a considerable role for pathophysiology of FOG in HIBI patients. Additional studies with a larger number of subjects are needed to further investigate the neural mechanism of FOG after HIBI.
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Affiliation(s)
- Seo Yeon Yoon
- From the Department of Rehabilitation Medicine, Bundang Jesaeng Hospital, Gyeonggi-do (SYY) and Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul (SCL, YWK), Republic of Korea
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Levin OS, Babkina OV. A role of the MAO-B inhibitor rasagiline in treatment of Parkinson’s disease. Zh Nevrol Psikhiatr Im S S Korsakova 2016. [DOI: 10.17116/jnevro20161167194-100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Tekin I, Carkaci-Salli N, Lewis MM, Mailman RB, Huang X, Vrana KE. The V81M variant of tyrosine hydroxylase is associated with more severe freezing of gait in Parkinson's disease. Parkinsonism Relat Disord 2015; 23:86-90. [PMID: 26732803 DOI: 10.1016/j.parkreldis.2015.12.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Revised: 12/10/2015] [Accepted: 12/20/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Many of the symptoms and signs of Parkinson's disease (PD) arise from the death of midbrain dopamine neurons that utilize tyrosine hydroxylase (TH) as the rate-limiting enzyme in catecholamine biosynthesis. METHODS We investigated whether the presence of a common TH polymorphism affects the clinical outcomes in 101 PD subjects. We further examined the effect of this polymorphism on the purified recombinant enzyme. RESULTS PD subjects homozygous for the common V81M polymorphism, have higher overall freezing of gait scores after controlling for disease duration, although this polymorphism does not associate with the occurrence of PD or FOG. In vitro functional assays on pure recombinant wild type TH and V81M TH revealed that the Km of the mutant enzyme for tyrosine was twice that of the wild-type. This polymorphism, however, did not change the stability of the enzyme, nor did it affect the Vmax or Km for the co-substrate BH4. CONCLUSION The data suggest that presence of a homozygous V81M polymorphism is associated with more severe FOG, possibly due to lower catecholamine synthetic capacity. Further studies are warranted to investigate the role of subtle changes in catecholamine availability in the development of FOG.
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Affiliation(s)
- Izel Tekin
- Department of Pharmacology, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Nurgul Carkaci-Salli
- Department of Pharmacology, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Mechelle M Lewis
- Department of Pharmacology, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, PA, USA; Department of Neurology, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Richard B Mailman
- Department of Pharmacology, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, PA, USA; Department of Neurology, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Xuemei Huang
- Department of Pharmacology, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, PA, USA; Department of Neurology, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, PA, USA; Departments of Radiology and Neurosurgery, Milton S. Hershey Medical Center, and Kinesiology, Pennsylvania State University, Hershey, PA, USA
| | - Kent E Vrana
- Department of Pharmacology, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, PA, USA.
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Pollak L, Dobronevsky Y, Prohorov T, Bahunker S, Rabey JM. Low dose methylphenidate improves freezing in advanced Parkinson's disease during off-state. JOURNAL OF NEURAL TRANSMISSION. SUPPLEMENTUM 2007:145-8. [PMID: 17982887 DOI: 10.1007/978-3-211-73574-9_17] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Five men with advanced idiopathic Parkinson's disease (PD) were examined to assess the effect of low dose methylphenidate (MPD) on gait. The patients were tested during "off" state before and two hours after the intake of 10 mg MPD while walking an "8 trajectory". The total walking time, total freezing time, number of freezing episodes and the non-freezing walking time were assessed. The obtained data were compared by the Wilcoxon Signed Rank test with a type I error rate of 0.05. The results showed a statistically significant improvement in all gait parameters after MPD intake. Moreover, a good correlation in the grade of improvement for each individual gait characteristic was found. The study demonstrates that low dose of MPD may improve gait, and especially freezing, in patients with severe PD, without the need for exogenous L-dopa. The mechanism of MPD action in patients with advanced PD is further discussed.
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Affiliation(s)
- L Pollak
- Assaf Harofeh Medical Center, Department of Neurology, Zerifin, Israel.
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Davis JT, Lyons KE, Pahwa R. Freezing of gait after bilateral subthalamic nucleus stimulation for Parkinson's disease. Clin Neurol Neurosurg 2005; 108:461-4. [PMID: 16139421 DOI: 10.1016/j.clineuro.2005.07.008] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2005] [Revised: 07/22/2005] [Accepted: 07/29/2005] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the long-term effect of bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) on freezing of gait in Parkinson's disease patients. PATIENTS AND METHODS Sixty-seven patients were followed 12 months after bilateral STN DBS and 32 patients were followed 24 months post-surgery. Patients were evaluated with the Unified Parkinson's Disease Rating Scale (UPDRS) with medications on and off at baseline and again in both conditions with stimulation on at follow-up. Specific attention was paid to the freezing item of the ADL section. RESULTS Freezing scores in the medication off state improved significantly with stimulation at 1 and 2 years. In the medication on state there were no significant improvements in freezing. CONCLUSION Off period freezing of gait is significantly improved with STN DBS up to 24 months; however, on period freezing is not affected by STN DBS.
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Affiliation(s)
- Justin T Davis
- University of Kansas Medical Center, Department of Neurology, 3599 Rainbow Blvd., Kansas City, KS 66160, USA
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