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Wang L, Sun H, Zhang H, Ji M, Gan C, Shan A, Cao X, Yuan Y, Zhang K. Effect of cerebrospinal dual-site magnetic stimulation on freezing of gait in Parkinson's disease. NPJ Parkinsons Dis 2024; 10:183. [PMID: 39349965 PMCID: PMC11442992 DOI: 10.1038/s41531-024-00792-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 09/05/2024] [Indexed: 10/04/2024] Open
Abstract
Addressing levodopa-unresponsive freezing of gait (FOG) in Parkinson's disease (PD) presents a significant challenge. A randomized double-blinded trial evaluated the effects of repetitive transcranial magnetic stimulation (rTMS) in conjunction with transcutaneous magnetic spinal cord stimulation among 57 PD individuals experiencing levodopa-unresponsive FOG. Patients were randomized to receive dual-site stimulation involving bilateral primary motor cortex of the lower leg (M1-LL) and the lumbar spinal cord, single-site stimulation targeting bilateral M1-LL alone, or sham stimulation for 10 sessions. Low-frequency rTMS induced remarkable improvements in FOG, gait, and motor functions compared to sham at 1 day and 1 month postintervention. Notably, the dual-site protocol demonstrated superior efficacy in mitigating FOG and improving gait compared to the single-site approach, which correlated with a pronounced increase in short-interval intracortical inhibition of the abductor pollicis brevis. These findings underscore the potential of the cerebrospinal dual-site regimen as a promising approach for levodopa-unresponsive FOG and gait in PD.
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Affiliation(s)
- Lina Wang
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Department of Neurology, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, Jiangsu, China
| | - Huimin Sun
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Heng Zhang
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Min Ji
- Department of Neurology, Hangzhou Lin'an TCM Hospital, Hangzhou, China
| | - Caiting Gan
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Aidi Shan
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xingyue Cao
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yongsheng Yuan
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Kezhong Zhang
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
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Jiao Y, Liu Z, Li J, Su Y, Chen X. Knowledge mapping of freezing of gait in Parkinson's disease: a bibliometric analysis. Front Neurosci 2024; 18:1388326. [PMID: 39315077 PMCID: PMC11417103 DOI: 10.3389/fnins.2024.1388326] [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: 02/19/2024] [Accepted: 08/27/2024] [Indexed: 09/25/2024] Open
Abstract
Objective Among the disturbing motor symptoms in Parkinson's disease (PD), freezing of gait (FOG) stands out as one of the most severe challenges. It typically arises during the initiation of gait or when turning. This phenomenon not only impose a heavy burden on patients, but also on their families. We conduct a bibliometric analysis to summarize current research hotspots and trends concerning freezing of gait in Parkinson's disease (PD-FOG) over past two decades. Methods We retrieved articles and reviews published in English about PD-FOG in the Web of science Core Collection database from 2000 to 2023 on November 30,2023. The tools VOSviewer and CiteSpace facilitated a visual analysis covering various aspects such as publications, countries/regions, organizations, authors, journals, cited references, and keywords. Result This study includes 1,340 articles from 64 countries/regions. There is a growth in publications related to PD-FOG over the past two decades, maintaining a stable high output since 2018, indicating a promising research landscape in the field of PD-FOG. The United States holds a leading position in this field, with Nieuwboer A and Giladi N being two of the most influential researchers. Over the past two decades, the research hotspots for PD-FOG have primarily encompassed the kinematic characteristics, diagnosis and detection, cognitive deficits and neural connectivity, as well as therapy and rehabilitation of PD-FOG. Topics including functional connectivity, virtual reality, deep learning and machine learning will be focal points of future research. Conclusion This is the first bibliometric analysis of PD-FOG. We construct this study to summarize the research in this field over past two decades, visually show the current hotspots and trends, and offer scholars in this field concepts and strategies for subsequent studies.
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Affiliation(s)
- Yue Jiao
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Zaichao Liu
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Juan Li
- Department of Neurology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yan Su
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xianwen Chen
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
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Lefaucheur JP, Moro E, Shirota Y, Ugawa Y, Grippe T, Chen R, Benninger DH, Jabbari B, Attaripour S, Hallett M, Paulus W. Clinical neurophysiology in the treatment of movement disorders: IFCN handbook chapter. Clin Neurophysiol 2024; 164:57-99. [PMID: 38852434 PMCID: PMC11418354 DOI: 10.1016/j.clinph.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 03/02/2024] [Accepted: 05/15/2024] [Indexed: 06/11/2024]
Abstract
In this review, different aspects of the use of clinical neurophysiology techniques for the treatment of movement disorders are addressed. First of all, these techniques can be used to guide neuromodulation techniques or to perform therapeutic neuromodulation as such. Neuromodulation includes invasive techniques based on the surgical implantation of electrodes and a pulse generator, such as deep brain stimulation (DBS) or spinal cord stimulation (SCS) on the one hand, and non-invasive techniques aimed at modulating or even lesioning neural structures by transcranial application. Movement disorders are one of the main areas of indication for the various neuromodulation techniques. This review focuses on the following techniques: DBS, repetitive transcranial magnetic stimulation (rTMS), low-intensity transcranial electrical stimulation, including transcranial direct current stimulation (tDCS) and transcranial alternating current stimulation (tACS), and focused ultrasound (FUS), including high-intensity magnetic resonance-guided FUS (MRgFUS), and pulsed mode low-intensity transcranial FUS stimulation (TUS). The main clinical conditions in which neuromodulation has proven its efficacy are Parkinson's disease, dystonia, and essential tremor, mainly using DBS or MRgFUS. There is also some evidence for Tourette syndrome (DBS), Huntington's disease (DBS), cerebellar ataxia (tDCS), and axial signs (SCS) and depression (rTMS) in PD. The development of non-invasive transcranial neuromodulation techniques is limited by the short-term clinical impact of these techniques, especially rTMS, in the context of very chronic diseases. However, at-home use (tDCS) or current advances in the design of closed-loop stimulation (tACS) may open new perspectives for the application of these techniques in patients, favored by their easier use and lower rate of adverse effects compared to invasive or lesioning methods. Finally, this review summarizes the evidence for keeping the use of electromyography to optimize the identification of muscles to be treated with botulinum toxin injection, which is indicated and widely performed for the treatment of various movement disorders.
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Affiliation(s)
- Jean-Pascal Lefaucheur
- Clinical Neurophysiology Unit, Henri Mondor University Hospital, AP-HP, Créteil, France; EA 4391, ENT Team, Paris-Est Créteil University, Créteil, France.
| | - Elena Moro
- Grenoble Alpes University, Division of Neurology, CHU of Grenoble, Grenoble Institute of Neuroscience, Grenoble, France
| | - Yuichiro Shirota
- Department of Neurology, Division of Neuroscience, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yoshikazu Ugawa
- Department of Human Neurophysiology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Talyta Grippe
- Division of Neurology, University of Toronto, Toronto, Ontario, Canada; Neuroscience Graduate Program, Federal University of Minas Gerais, Belo Horizonte, Brazil; Krembil Brain Institute, Toronto, Ontario, Canada
| | - Robert Chen
- Division of Neurology, University of Toronto, Toronto, Ontario, Canada; Krembil Brain Institute, Toronto, Ontario, Canada
| | - David H Benninger
- Service of Neurology, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Bahman Jabbari
- Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
| | - Sanaz Attaripour
- Department of Neurology, University of California, Irvine, CA, USA
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Walter Paulus
- Department of Neurology, Ludwig Maximilians University, Munich, Germany
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Niemrungruang K, Thanakamchokchai J, Pongmala C, Khobkhun F. The effects of combining repetitive transcranial magnetic stimulation with task-specific training on gait performance in individuals with Parkinson's disease: A review article. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2024; 29:e2105. [PMID: 38864408 DOI: 10.1002/pri.2105] [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: 01/12/2024] [Revised: 04/11/2024] [Accepted: 05/28/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND Parkinson's disease (PD) is a neurodegenerative disorder characterized by motor impairments, especially in the area of gait disturbances. Physiotherapy, with a focus on task-specific training, has demonstrated a level of efficacy as regards alleviating symptoms and enhancing functional capabilities in individuals with PD. Repetitive Transcranial Magnetic Stimulation (rTMS) has emerged as a potential therapeutic intervention for improving motor functions in individuals with PD. AIMS This review article aims to investigate the effects of combining rTMS with task-specific training on gait performance in individuals with PD. MATERIALS AND METHODS PubMed, Physiotherapy Evidence Database (PEDro), and Scopus were all searched for relevant studies. The focus of the search was on studies that investigated the efficacy of combining rTMS with task-specific training to improve gait performance in individuals with PD. RESULTS Four studies were identified as fulfilling the eligibility criteria and were included in the study. The combination of rTMS with specific treadmill training and weight-bearing exercises can significantly enhance walking efficiency, including improvements in walking speed, self-mobility, and step rate. In addition, the combination of rTMS and task-specific training, such as treadmill-based training, shows promise in enhancing gait performance in individuals with PD. DISCUSSION AND CONCLUSION High-frequency rTMS targeting the primary motor cortex (or M1) can result in improved walking speed, self-mobility, and step rate. However, limited research exists regarding low-frequency stimulation of the supplementary motor area (SMA) in individuals with gait issues. Further research is required to determine the optimal parameters of rTMS, such as strength, frequency, and duration of stimulation and it is worth considering the incorporation of additional training modalities, including cognitive exercises.
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Affiliation(s)
- Kanjana Niemrungruang
- Physical Therapy Center, Faculty of Physical Therapy, Mahidol University, Bangkok, Thailand
| | - Jenjira Thanakamchokchai
- Parkinson Movement and Research Collaboration Laboratory, Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand
| | - Chatkaew Pongmala
- Functional Neuroimaging, Cognitive and Mobility Laboratory, Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Fuengfa Khobkhun
- Parkinson Movement and Research Collaboration Laboratory, Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand
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Wang Y, Ding Y, Guo C. Assessment of noninvasive brain stimulation interventions in Parkinson's disease: a systematic review and network meta-analysis. Sci Rep 2024; 14:14219. [PMID: 38902308 PMCID: PMC11189909 DOI: 10.1038/s41598-024-64196-0] [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: 02/17/2024] [Accepted: 06/06/2024] [Indexed: 06/22/2024] Open
Abstract
A network meta-analysis of randomized controlled trials was conducted to compare and rank the effectiveness of various noninvasive brain stimulation (NIBS) for Parkinson's disease (PD). We searched PubMed, Web of Science, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), Wanfang Database, China Science and Technology Journal Database (VIP), and Chinese Biomedical Literature Service System (SinoMed) databases from the date of database inception to April 30th, 2024. Two researchers independently screened studies of NIBS treatment in patients with PD based on inclusion and exclusion criteria. Two researchers independently performed data extraction of the included studies using an Excel spreadsheet and assessed the quality of the literature according to the Cochrane Risk of Bias Assessment Tool (RoB2). Network meta-analysis was performed in StataMP 17.0. A total of 28 studies involving 1628 PD patients were included. The results showed that HF-rTMS over the SMA (SMD = - 2.01; 95% CI [- 2.87, - 1.15]), HF-rTMS over the M1 and DLPFC (SMD = - 1.80; 95% CI [- 2.90, - 0.70]), HF-rTMS over the M1 (SMD = - 1.10; 95% CI [- 1.55, - 0.65]), a-tDCS over the DLPFC (SMD = - 1.08; 95% CI [- 1.90, - 0.27]), HF-rTMS over the M1 and PFC (SMD = - 0.92; 95% CI [- 1.71, - 0.14]), LF-rTMS over the M1 (SMD = - 0.72; 95% CI [- 1.17, - 0.28]), and HF-rTMS over the DLPFC (SMD = - 0.70; 95% CI [- 1.21, - 0.19]) were significantly improved motor function compared with sham stimulation. The SUCRA three highest ranked were HF-rTMS over the SMA (95.1%), HF-rTMS over the M1 and DLPFC (89.6%), and HF-rTMS over the M1 (73.0%). In terms of enhanced cognitive function, HF-rTMS over the DLPFC (SMD = 0.80; 95% CI [0.03,1.56]) was significantly better than sham stimulation. The SUCRA three most highly ranked were a-tDCS over the M1 (69.8%), c-tDCS over the DLPFC (66.9%), and iTBS over the DLPFC (65.3%). HF-rTMS over the M1 (SMD = - 1.43; 95% CI [- 2.26, - 0.61]) and HF-rTMS over the DLPFC (SMD = - 0.79; 95% CI [- 1.45, - 0.12)]) significantly improved depression. The SUCRA three highest ranked were HF-rTMS over the M1 (94.1%), LF-rTMS over the M1 (71.8%), and HF-rTMS over the DLPFC (69.0%). HF-rTMS over the SMA may be the best option for improving motor symptoms in PD patients. a-tDCS and HF-rTMS over the M1 may be the NIBS with the most significant effects on cognition and depression, separately.Trial registration: International Prospective Register of Systematic Review, PROSPERO (CRD42023456088).
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Affiliation(s)
- Yueying Wang
- College of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yi Ding
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China.
| | - Chenchen Guo
- Department of Rehabilitation Medicine, Neck, Shoulder, Lumbago and Leg Pain Hospital Affiliated to Shandong First Medical University, Jinan, China.
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Shao Z, Tan Y, Zhan Y, He L. Modular organization of functional brain networks in patients with degenerative cervical myelopathy. Sci Rep 2024; 14:8593. [PMID: 38615051 PMCID: PMC11016091 DOI: 10.1038/s41598-024-58764-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 04/03/2024] [Indexed: 04/15/2024] Open
Abstract
Previous studies have indicated that brain functional plasticity and reorganization in patients with degenerative cervical myelopathy (DCM). However, the effects of cervical cord compression on the functional integration and separation between and/or within modules remain unclear. This study aimed to address these questions using graph theory. Functional MRI was conducted on 46 DCM patients and 35 healthy controls (HCs). The intra- and inter-modular connectivity properties of the whole-brain functional network and nodal topological properties were then calculated using theoretical graph analysis. The difference in categorical variables between groups was compared using a chi-squared test, while that between continuous variables was evaluated using a two-sample t-test. Correlation analysis was conducted between modular connectivity properties and clinical parameters. Modules interaction analyses showed that the DCM group had significantly greater inter-module connections than the HCs group (DMN-FPN: t = 2.38, p = 0.02); inversely, the DCM group had significantly lower intra-module connections than the HCs group (SMN: t = - 2.13, p = 0.036). Compared to HCs, DCM patients exhibited higher nodal topological properties in the default-mode network and frontal-parietal network. In contrast, DCM patients exhibited lower nodal topological properties in the sensorimotor network. The Japanese Orthopedic Association (JOA) score was positively correlated with inter-module connections (r = 0.330, FDR p = 0.029) but not correlated with intra-module connections. This study reported alterations in modular connections and nodal centralities in DCM patients. Decreased nodal topological properties and intra-modular connection in the sensory-motor regions may indicate sensory-motor dysfunction. Additionally, increased nodal topological properties and inter-modular connection in the default mode network and frontal-parietal network may serve as a compensatory mechanism for sensory-motor dysfunction in DCM patients. This could provide an implicative neural basis to better understand alterations in brain networks and the patterns of changes in brain plasticity in DCM patients.
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Affiliation(s)
- Ziwei Shao
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, China
- Clinical Research Center for Medical Imaging In Jiangxi Province, Nanchang, China
| | - Yongming Tan
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, China
- Clinical Research Center for Medical Imaging In Jiangxi Province, Nanchang, China
| | - Yaru Zhan
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, China
- Clinical Research Center for Medical Imaging In Jiangxi Province, Nanchang, China
| | - Laichang He
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, China.
- Clinical Research Center for Medical Imaging In Jiangxi Province, Nanchang, China.
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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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Quek DYL, Taylor N, Gilat M, Lewis SJG, Ehgoetz Martens KA. Effect of dopamine on limbic network connectivity at rest in Parkinson's disease patients with freezing of gait. Transl Neurosci 2024; 15:20220336. [PMID: 38708096 PMCID: PMC11066616 DOI: 10.1515/tnsci-2022-0336] [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: 12/22/2023] [Revised: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 05/07/2024] Open
Abstract
Background Freezing of gait (FOG) in Parkinson's disease (PD) has a poorly understood pathophysiology, which hinders treatment development. Recent work showed a dysfunctional fronto-striato-limbic circuitry at rest in PD freezers compared to non-freezers in the dopamine "OFF" state. While other studies found that dopaminergic replacement therapy alters functional brain organization in PD, the specific effect of dopamine medication on fronto-striato-limbic functional connectivity in freezers remains unclear. Objective To evaluate how dopamine therapy alters resting state functional connectivity (rsFC) of the fronto-striato-limbic circuitry in PD freezers, and whether the degree of connectivity change is related to freezing severity and anxiety. Methods Twenty-three PD FOG patients underwent MRI at rest (rsfMRI) in their clinically defined "OFF" and "ON" dopaminergic medication states. A seed-to-seed based analysis was performed between a priori defined limbic circuitry ROIs. Functional connectivity was compared between OFF and ON states. A secondary correlation analyses evaluated the relationship between Hospital Anxiety and Depression Scale (HADS)-Anxiety) and FOG Questionnaire with changes in rsFC from OFF to ON. Results PD freezers' OFF compared to ON showed increased functional coupling between the right hippocampus and right caudate nucleus, and between the left putamen and left posterior parietal cortex (PPC). A negative association was found between HADS-Anxiety and the rsFC change from OFF to ON between the left amygdala and left prefrontal cortex, and left putamen and left PPC. Conclusion These findings suggest that dopaminergic medication partially modulates the frontoparietal-limbic-striatal circuitry in PD freezers, and that the influence of medication on the amygdala, may be related to clinical anxiety in freezer.
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Affiliation(s)
- Dione Y. L. Quek
- Parkinson’s Disease Research Clinic, Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Natasha Taylor
- Parkinson’s Disease Research Clinic, Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Moran Gilat
- Neurorehabilitation Research Group (eNRGy), Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Simon J. G. Lewis
- Parkinson’s Disease Research Clinic, Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Kaylena A. Ehgoetz Martens
- Parkinson’s Disease Research Clinic, Brain and Mind Centre, University of Sydney, Sydney, Australia
- Department of Kinesiology and Health Sciences, University of Waterloo, 200 University Avenue West, WaterlooON, N2L3G1Canada
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Wei Y, Ye S, Jiang H, Chen Y, Qiu Y, Zhang L, Ma R, Gao Q. Effects of non-invasive brain stimulation over supplementary motor area in people with Parkinson's disease: a protocol for a systematic review and meta-analysis of randomised controlled trials. BMJ Open 2023; 13:e076948. [PMID: 38070907 PMCID: PMC10729189 DOI: 10.1136/bmjopen-2023-076948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 11/19/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Individuals with Parkinson's disease (PD) often experience initial hesitation, slowness of movements, decreased balance and impaired standing ability, which can significantly impact their independence. Transcranial magnetic stimulation and transcranial direct current stimulation are two widely used and promising non-invasive brain stimulation (NIBS) modalities for treating PD. The supplementary motor area (SMA), associated with motor behaviour and processing, has received increasing attention as a potential stimulation target to alleviate PD-related symptoms. However, the data on NIBS over SMA in PD individuals are inconsistent and has not been synthesised. In this article, we will review the evidence for NIBS over SMA in PD individuals and evaluate its efficacy in improving PD function. METHOD AND ANALYSIS Randomised controlled clinical trials comparing the effects of NIBS and sham stimulation on motor function, activities of daily living and participation for people with PD will be included. A detailed computer-aided search of the literature will be performed from inception to February 2023 in the following databases: PubMed, EMBASE, Physiotherapy Evidence Database (PEDro), Web of Science (WOS) and The Chinese National Knowledge Infrastructure (CNKI). Two independent reviewers will screen articles for relevance and methodological validity. The PEDro scale will be used to evaluate the risk of bias of selected studies. Data from included studies will be extracted by two independent reviewers through a customised, preset data extraction sheet. ETHICS AND DISSEMINATION Ethical approval is not required for this systematic review. The study's findings will be presented at scientific meetings and published in peer-reviewed journals. PROSPERO REGISTRATION NUMBER CRD42023399945.
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Affiliation(s)
- Yixin Wei
- Department of Rehabilitation Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Saiqing Ye
- Department of Rehabilitation Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Hanhong Jiang
- Department of Rehabilitation Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Yawen Chen
- Department of Rehabilitation Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital of Sichuan University, Chengdu, Sichuan, China
- Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong, People's Republic of China
| | - Yitong Qiu
- Department of Rehabilitation Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Li Zhang
- Department of Rehabilitation Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Runting Ma
- Department of Rehabilitation Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Qiang Gao
- Department of Rehabilitation Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital of Sichuan University, Chengdu, Sichuan, China
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Chen XY, Feng SN, Bao Y, Zhou YX, Ba F. Identification of Clec7a as the therapeutic target of rTMS in alleviating Parkinson's disease: targeting neuroinflammation. Biochim Biophys Acta Mol Basis Dis 2023; 1869:166814. [PMID: 37495085 DOI: 10.1016/j.bbadis.2023.166814] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 06/25/2023] [Accepted: 07/20/2023] [Indexed: 07/28/2023]
Abstract
Parkinson's disease (PD) is a neurodegenerative disease. Repetitive transcranial magnetic stimulation (rTMS) is a therapeutic tool in PD. High-throughput sequencing was performed to screen potential therapeutic targets in unilaterally 6-hydroxydopamine (6-OHDA)-lesioned rats. The candidate gene, Clec7a, was screened out and validated. Clec7a is a pattern recognition receptor involved in neuroinflammation. The higher expression of Clec7a was observed in the substantia nigra (SN) and striatum of PD rats with dopaminergic neurons damage and was mainly localized in the microglial. Adeno-associated virus (AAV)-mediated specific knockdown of Clec7a in microglial alleviated 6-OHDA induced motor deficits and nigrostriatal dopaminergic neuron damage of rats, as evidenced by the increase of tyrosine hydroxylase (TH) -positive neurons in SN, as well as dopaminergic nerve fibers in the striatum. Clec7a knockdown restrained the neuroinflammation by suppressing inflammatory factors (IFN-γ, TNF-α, IL-1β, IL-18, and IL-6) release in SN, which might result from enhanced Arg-1 expression (M2 polarization) and defective inducible nitric oxide synthase (iNOS) expression (M1 polarization). The same phenomena were also observed in the LPS inflammatory rat model of PD. In vitro, α-synuclein fibrils induced upregulation of Clec7a expression and microglia polarization to a pro-inflammatory state of BV2 cells, leading to increased release of cytokines. However, Clec7a knockdown reversed those changes and induced a shift to an anti-inflammatory phenotype in BV2 cells. In conclusion, our study suggested that Clec7a was involved in PD pathogenesis, and its inhibition might protect rats from PD by depressing neuroinflammation through microglial polarization.
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Affiliation(s)
- Xue-Yun Chen
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning, China
| | - Si-Ning Feng
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning, China
| | - Yin Bao
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning, China
| | - Yu-Xin Zhou
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning, China
| | - Fang Ba
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning, China.
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Sun H, Gan C, Wang L, Ji M, Cao X, Yuan Y, Zhang H, Shan A, Gao M, Zhang K. Cortical Disinhibition Drives Freezing of Gait in Parkinson's Disease and an Exploratory Repetitive Transcranial Magnetic Stimulation Study. Mov Disord 2023; 38:2072-2083. [PMID: 37646183 DOI: 10.1002/mds.29595] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 08/14/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Dysfunction of the primary motor cortex, participating in regulation of posture and gait, is implicated in freezing of gait (FOG) in Parkinson's disease (PD). OBJECTIVE The aim was to reveal the mechanisms of "OFF-period" FOG (OFF-FOG) and "levodopa-unresponsive" FOG (ONOFF-FOG) in PD. METHODS We measured the transcranial magnetic stimulation (TMS) indicators and gait parameters in 21 healthy controls (HCs), 15 PD patients with ONOFF-FOG, 15 PD patients with OFF-FOG, and 15 PD patients without FOG (Non-FOG) in "ON" and "OFF" medication conditions. Difference of TMS indicators in the four groups and two conditions and its correlations with gait parameters were explored. Additionally, we explored the effect of 10 Hz repetitive TMS on gait and TMS indicators in ONOFF-FOG patients. RESULTS In "OFF" condition, short interval intracortical inhibition (SICI) exhibited remarkable attenuation in FOG patients (both ONOFF-FOG and OFF-FOG) compared to Non-FOG patients and HCs. The weakening of SICI correlated with impaired gait characteristics in FOG. However, in "ON" condition, SICI in ONOFF-FOG patients reduced compared to OFF-FOG patients. Pharmacological treatment significantly improved SICI and gait in OFF-FOG patients, and high-frequency repetitive TMS distinctly improved gait in ONOFF-FOG patients, accompanied by enhanced SICI. CONCLUSIONS Motor cortex disinhibition, represented by decreased SICI, is related to FOG in PD. Refractory freezing in ONOFF-FOG patients correlated with the their reduced SICI insensitive to dopaminergic medication. SICI can serve as an indicator of the severity of impaired gait characteristics in FOG and reflect treatments efficacy for FOG in PD patients. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Huimin Sun
- Department of Neurology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Caiting Gan
- Department of Neurology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Lina Wang
- Department of Neurology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Min Ji
- Department of Neurology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xingyue Cao
- Department of Neurology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yongsheng Yuan
- Department of Neurology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Heng Zhang
- Department of Neurology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Aidi Shan
- Department of Neurology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Mengxi Gao
- Department of Neurology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Kezhong Zhang
- Department of Neurology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, 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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Yang Y, Wang Y, Gao T, Reyila A, Liu J, Liu J, Han H. Effect of Physiotherapy Interventions on Motor Symptoms in People With Parkinson's Disease: A Systematic Review and Meta-Analysis. Biol Res Nurs 2023; 25:586-605. [PMID: 37070664 DOI: 10.1177/10998004231171587] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of different types of physiotherapy interventions in people with Parkinson's disease (PD). DESIGN Systematic review and meta-analysis of randomized controlled trials (RCTs). METHODS Five databases (PubMed, Embase, Cochrane Library, CINAHL and Web of Science Core Collection) were searched for relevant RCTs published from database inception to July 14, 2022. Reviewers independently screened the literature, extracted data, and assessed the literature quality according to the Cochrane Collaboration Risk of Bias Tool and PEDro Scale. This meta-analysis was conducted using RevMan 5.4.1 and reported in compliance with the PRISMA statement. RESULTS Forty-two RCTs with 2,530 participants were included. Across all types of physiotherapy, strength training, mind-body exercise, aerobic exercise, and non-invasive brain stimulation (NiBS) were effective in improving motor symptoms as measured by the (Movement Disorders Society-) Unified PD Scale, whereas balance and gait training (BGT) and acupuncture were not. The pooled results showed that the change in mind-body exercise (MD = -5.36, 95% CI [-7.97 to -2.74], p < .01, I2 = 68%) and NiBS (MD = -4.59, 95% CI [-8.59 to -0.59], p = .02, I2 = 78%) reached clinical threshold, indicating clinically meaningful improvements. Considering the effectiveness of the interventions on motor symptoms, balance, gait and functional mobility, mind-body exercise was recommended the most. CONCLUSIONS Exercise appears to be a better form of physiotherapy than NiBS and acupuncture for improving motor function. Mind-body exercise showed beneficial effects on motor symptoms, balance, gait and functional mobility in people with PD, and is worthy of being promoted.
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Affiliation(s)
- Yajie Yang
- School of Nursing, Peking University, Beijing 100191, China
| | - Yang Wang
- Institute of Medical Technology, Peking University Health Science Center, Beijing 100191, China
| | - Tianzi Gao
- Institute of Medical Technology, Peking University Health Science Center, Beijing 100191, China
| | | | - Jiaxin Liu
- Xiangya School of Nursing, Central South University, Changsha 410013, China
| | - Jiajia Liu
- School of Nursing, Peking University, Beijing 100191, China
| | - Hongbin Han
- Institute of Medical Technology, Peking University Health Science Center, Beijing 100191, China
- Department of Radiology, Peking University Third Hospital, Beijing 100191, China
- NMPA Key Laboratory for Evaluation of Medical Imaging Equipment and Technique, Beijing, China
- Beijing Key Laboratory of Magnetic Resonance Imaging Technology, Beijing 100191, China
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Liu X, Li L, Liu Y. Comparative motor effectiveness of non-invasive brain stimulation techniques in patients with Parkinson's disease: A network meta-analysis. Medicine (Baltimore) 2023; 102:e34960. [PMID: 37773851 PMCID: PMC10545289 DOI: 10.1097/md.0000000000034960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 08/04/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND Although noninvasive brain stimulation (NIBS) techniques are an effective alternative treatment option, their relative effects in patients with Parkinson's disease (PD) remain undefined. Here, we aimed to compare motor efficacy of the NIBS techniques in PD. METHODS We carried out an electronic search in PubMed, Embase, Cochrane Library, CINAHL, PEDro and PsycINFO (accessed via Ovid) for articles published until August 2022. The treatment efficacy of motor function was quantified by the Unified Parkinson's disease rating scale part III. RESULTS 28 randomized controlled trials with parallel group were included in the analysis, enrolling 1057 patients. In the "on" state, high-frequency repetitive transcranial magnetic stimulation (HFrTMS) conferred better short-term and long-term efficacy compared to transcranial direct current stimulation. Surface under the cumulative ranking curve rank showed that HFrTMS combined with transcranial direct current stimulation and low-frequency TMS ranked first among PD in improving motor function. In the "off" state, there were no significant differences in most of the treatments, but surface under the cumulative ranking curve rank showed that continuous theta burst stimulation and low-frequency TMS had the highest short- and long-term effect in improving motor function. CONCLUSION HFrTMS is an effective intervention in improving motor function. Besides, its combination with another NIBS technique produces better therapeutic effects in the "on" state.
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Affiliation(s)
- Xuan Liu
- Beijing Sport University, Beijing, China
| | - Lei Li
- Beijing Chunlizhengda Medical Instruments Co., Ltd, Beijing, China
| | - Ye Liu
- Beijing Sport University, Beijing, China
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15
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Qiu Y, Yin Z, Wang M, Duan A, Xie M, Wu J, Wang Z, Chen G. Motor function improvement and acceptability of non-invasive brain stimulation in patients with Parkinson's disease: a Bayesian network analysis. Front Neurosci 2023; 17:1212640. [PMID: 37564368 PMCID: PMC10410144 DOI: 10.3389/fnins.2023.1212640] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/11/2023] [Indexed: 08/12/2023] Open
Abstract
Background Parkinson's disease (PD) is a neurodegenerative disorder defined by progressive motor and non-motor symptoms. Currently, the pro-cognitive effects of transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS) are well-supported in previous literatures. However, controversy surrounding the optimal therapeutic target for motor symptom improvement remains. Objective This network meta-analysis (NMA) was conducted to comprehensively evaluate the optimal strategy to use rTMS and tDCS to improve motor symptoms in PD. Methods We searched PubMed, Embase, and Cochrane electronic databases for eligible randomized controlled studies (RCTs). The primary outcome was the changes of Unified Parkinson's Disease Rating Scale (UPDRS) part III score, the secondary outcomes were Time Up and Go Test (TUGT) time, and Freezing of Gait Questionnaire (FOGQ) score. The safety outcome was indicated by device-related adverse events (AEs). Result We enrolled 28 studies that investigated various strategies, including high-frequency rTMS (HFrTMS), low-frequency rTMS (LFrTMS), anodal tDCS (AtDCS), AtDCS_ cathode tDCS (CtDCS), HFrTMS_LFrTMS, and Sham control groups. Both HFrTMS (short-term: mean difference (MD) -5.21, 95% credible interval (CrI) -9.26 to -1.23, long-term: MD -4.74, 95% CrI -6.45 to -3.05), and LFrTMS (long-term: MD -4.83, 95% CrI -6.42 to -3.26) were effective in improving UPDRS-III score compared with Sham stimulation. For TUGT time, HFrTMS (short-term: MD -2.04, 95% CrI -3.26 to -0.8, long-term: MD -2.66, 95% CrI -3.55 to -1.77), and AtDCS (short-term: MD -0.8, 95% CrI -1.26 to -0.34, long-term: MD -0.69, 95% CrI -1.31 to -0.08) produced a significant difference compared to Sham stimulation. However, no statistical difference was found in FOGQ score among the various groups. According to the surface under curve ranking area, HFrTMS ranked first in short-term UPDRS-III score (0.77), short-term (0.82), and long-term (0.84) TUGT time, and short-term FOGQ score (0.73). With respect to the safety outcomes, all strategies indicated few and self-limiting AEs. Conclusion HFrTMS may be the optimal non-invasive brain stimulation (NIBS) intervention to improve motor function in patients with PD while NIBS has generally been well tolerated. However, further studies focusing on the clinical outcomes resulting from the different combined schedules of tDCS and rTMS are required. Systematic review registration https://inplasy.com/inplasy-2023-4-0087/, identifier: 202340087.
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Affiliation(s)
- Youjia Qiu
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Ziqian Yin
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Menghan Wang
- Suzhou Medical College of Soochow University, Suzhou, China
| | - Aojie Duan
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Minjia Xie
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jiang Wu
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhong Wang
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Gang Chen
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
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16
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Dong K, Zhu X, Xiao W, Gan C, Luo Y, Jiang M, Liu H, Chen X. Comparative efficacy of transcranial magnetic stimulation on different targets in Parkinson's disease: A Bayesian network meta-analysis. Front Aging Neurosci 2023; 14:1073310. [PMID: 36688161 PMCID: PMC9845788 DOI: 10.3389/fnagi.2022.1073310] [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: 10/18/2022] [Accepted: 12/05/2022] [Indexed: 01/05/2023] Open
Abstract
Background/Objective The efficacy of transcranial magnetic stimulation (TMS) on Parkinson's disease (PD) varies across the stimulation targets. This study aims to estimate the effect of different TMS targets on motor symptoms in PD. Methods A Bayesian hierarchical model was built to assess the effects across different TMS targets, and the rank probabilities and the surface under the cumulative ranking curve (SUCRA) values were calculated to determine the ranks of each target. The primary outcome was the Unified Parkinson's Disease Rating Scale part-III. Inconsistency between direct and indirect comparisons was assessed using the node-splitting method. Results Thirty-six trials with 1,122 subjects were included for analysis. The pair-wise meta-analysis results showed that TMS could significantly improve motor symptoms in PD patients. Network meta-analysis results showed that the high-frequency stimulation over bilateral M1, bilateral DLPFC, and M1+DLPFC could significantly reduce the UPDRS-III scores compared with sham conditions. The high-frequency stimulation over both M1 and DLPFC had a more significant effect when compared with other parameters, and ranked first with the highest SCURA value. There was no significant inconsistency between direct and indirect comparisons. Conclusion Considering all settings reported in our research, high-frequency stimulation over bilateral M1 or bilateral DLPFC has a moderate beneficial effect on the improvement of motor symptoms in PD (high confidence rating). High-frequency stimulation over M1+DLPFC has a prominent beneficial effect and appears to be the most effective TMS parameter setting for ameliorating motor symptoms of PD patients (high confidence rating).
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Affiliation(s)
- Ke Dong
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaoxia Zhu
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wenwu Xiao
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Chu Gan
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yulu Luo
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Manying Jiang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hanjun Liu
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China,Guangdong Provincial Key Laboratory of Brain Function and Disease, Zhongshan School of Medicine, Guangzhou, China,Hanjun Liu,
| | - Xi Chen
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China,*Correspondence: Xi Chen,
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Wang J, Deng X, Hu Y, Yue J, Ge Q, Li X, Feng Z. Low-frequency rTMS targeting individual self-initiated finger-tapping task activation modulates the amplitude of local neural activity in the putamen. Hum Brain Mapp 2023; 44:203-217. [PMID: 36562546 PMCID: PMC9783468 DOI: 10.1002/hbm.26045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 06/11/2022] [Accepted: 07/25/2022] [Indexed: 02/05/2023] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) has been used in the clinical treatment of Parkinson's disease (PD). Most of rTMS studies on PD used high-frequency stimulation; however, excessive nonvoluntary movement may represent abnormally cortical excitability, which is likely to be suppressed by low-frequency rTMS. Decreased neural activity in the basal ganglia on functional magnetic resonance imaging (fMRI) is a characteristic of PD. In the present study, we found that low-frequency (1 Hz) rTMS targeting individual finger-tapping activation elevated the amplitude of local neural activity (percentage amplitude fluctuation, PerAF) in the putamen as well as the functional connectivity (FC) of the stimulation target and basal ganglia in healthy participants. These results provide evidence for our hypothesis that low-frequency rTMS over the individual task activation site can modulate deep brain functions, and that FC might serve as a bridge transmitting the impact of rTMS to the deep brain regions. It suggested that a precisely localized individual task activation site can act as a target for low-frequency rTMS when it is used as a therapeutic tool for PD.
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Affiliation(s)
- Jue Wang
- Institute of Sports Medicine and HealthChengdu Sport UniversityChengduPeople's Republic of China
| | - Xin‐Ping Deng
- Institutes of Psychological SciencesHangzhou Normal UniversityHangzhouPeople's Republic of China
- Zhejiang Key Laboratory for Research in Assessment of Cognitive ImpairmentsHangzhouPeople's Republic of China
- Center for Cognition and Brain DisordersThe Affiliated Hospital of Hangzhou Normal UniversityHangzhouPeople's Republic of China
| | - Yun‐Song Hu
- Institutes of Psychological SciencesHangzhou Normal UniversityHangzhouPeople's Republic of China
- Zhejiang Key Laboratory for Research in Assessment of Cognitive ImpairmentsHangzhouPeople's Republic of China
- Center for Cognition and Brain DisordersThe Affiliated Hospital of Hangzhou Normal UniversityHangzhouPeople's Republic of China
| | - Juan Yue
- Institutes of Psychological SciencesHangzhou Normal UniversityHangzhouPeople's Republic of China
- Zhejiang Key Laboratory for Research in Assessment of Cognitive ImpairmentsHangzhouPeople's Republic of China
- Center for Cognition and Brain DisordersThe Affiliated Hospital of Hangzhou Normal UniversityHangzhouPeople's Republic of China
| | - Qiu Ge
- Institutes of Psychological SciencesHangzhou Normal UniversityHangzhouPeople's Republic of China
- Zhejiang Key Laboratory for Research in Assessment of Cognitive ImpairmentsHangzhouPeople's Republic of China
- Center for Cognition and Brain DisordersThe Affiliated Hospital of Hangzhou Normal UniversityHangzhouPeople's Republic of China
| | - Xiao‐Long Li
- Institutes of Psychological SciencesHangzhou Normal UniversityHangzhouPeople's Republic of China
- Zhejiang Key Laboratory for Research in Assessment of Cognitive ImpairmentsHangzhouPeople's Republic of China
- Center for Cognition and Brain DisordersThe Affiliated Hospital of Hangzhou Normal UniversityHangzhouPeople's Republic of China
| | - Zi‐Jian Feng
- Institutes of Psychological SciencesHangzhou Normal UniversityHangzhouPeople's Republic of China
- Zhejiang Key Laboratory for Research in Assessment of Cognitive ImpairmentsHangzhouPeople's Republic of China
- Center for Cognition and Brain DisordersThe Affiliated Hospital of Hangzhou Normal UniversityHangzhouPeople's Republic of China
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18
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Zhang W, Deng B, Xie F, Zhou H, Guo JF, Jiang H, Sim A, Tang B, Wang Q. Efficacy of repetitive transcranial magnetic stimulation in Parkinson's disease: A systematic review and meta-analysis of randomised controlled trials. EClinicalMedicine 2022; 52:101589. [PMID: 35923424 PMCID: PMC9340539 DOI: 10.1016/j.eclinm.2022.101589] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 07/09/2022] [Accepted: 07/12/2022] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive form of brain stimulation that positively regulates the motor and non-motor symptoms of Parkinson's disease (PD). Although, most reviews and meta-analysis have shown that rTMS intervention is effective in treating motor symptoms and depression, very few have used randomised controlled trials (RCTs) to analyse the efficacy of this intervention in PD. We aimed to review RCTs of rTMS in patients with PD to assess the efficacy of rTMS on motor and non-motor function in patients with PD. METHODS In this systematic review and meta-analysis, we searched PubMed, MEDLINE and Web of Science databases for RCTs on rTMS in PD published between January 1, 1988 to January 1, 2022. Eligible studies included sham-controlled RCTs that used rTMS stimulation for motor or non-motor symptoms in PD. RCTs not focusing on the efficacy of rTMS in PD were excluded. Summary data were extracting from those RCTs by two investigators independently. We then calculated standardised mean difference with random-effect models. The main outcome included motor and non-motor examination of scales that were used in PD motor or non-motor assessment. This study was registered with PROSPERO, CRD42022329633. FINDINGS Fourteen studies with 469 patients met the criteria for our meta-analysis. Twelve eligible studies with 381 patients were pooled to analyse the efficacy of rTMS on motor function improvement. The effect size on motor scale scores was 0.51 (P < 0.0001) and were not distinctly heterogeneous (I2 = 29%). Five eligible studies with 202 patients were collected to evaluate antidepressant-like effects. The effect size on depression scale scores was 0.42 (P = 0.004), and were not distinctly heterogeneous (I2 = 25%), indicating a significant anti-depressive effect (P = 0.004). The results suggest that high-frequency of rTMS on primary motor cortex (M1) is effective in improving motor symptoms; while the dorsolateral prefrontal cortex (DLPFC) may be a potentially effective area in alleviating depressive symptom. INTERPRETATION The findings suggest that rTMS could be used as a possible adjuvant therapy for PD mainly to improve motor symptoms, but could have potential efficacy on depressive symptoms of PD. However, further investigation is needed. FUNDING The National Natural Science Foundation of China (NO: 81873777, 82071414), Initiated Foundation of Zhujiang Hospital (NO: 02020318005), Scientific Research Foundation of Guangzhou (NO: 202206010005), and Science and Technology Program of Guangdong of China (NO: 2020A0505100037).
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Affiliation(s)
- Wenjie Zhang
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong 510282, PR China
| | - Bin Deng
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong 510282, PR China
| | - Fen Xie
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong 510282, PR China
| | - Hang Zhou
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong 510282, PR China
| | - Ji-Feng Guo
- Department of Neurology, Xiangya Hospital, Central South University, Changsha 410008, PR China
| | - Hong Jiang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha 410008, PR China
| | - Amy Sim
- Department of Neurology, Texas Tech University Health Sciences Centre El Paso, El Paso, TX 79905, USA
| | - Beisha Tang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha 410008, PR China
| | - Qing Wang
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong 510282, PR China
- Corresponding author at: Department of Neurology, Zhujiang Hospital, Southern Medical University, Gongye Road 253, Guangzhou, Guangdong Province 510282, PR China.
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Bagarinao E, Kawabata K, Watanabe H, Hara K, Ohdake R, Ogura A, Masuda M, Kato T, Maesawa S, Katsuno M, Sobue G. Connectivity impairment of cerebellar and sensorimotor connector hubs in Parkinson’s disease. Brain Commun 2022; 4:fcac214. [PMID: 36072644 PMCID: PMC9438962 DOI: 10.1093/braincomms/fcac214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 05/25/2022] [Accepted: 08/19/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Cognitive and movement processes involved integration of several large-scale brain networks. Central to these integrative processes are connector hubs, brain regions characterized by strong connections with multiple networks. Growing evidence suggests that many neurodegenerative and psychiatric disorders are associated with connector hub dysfunctions. Using a network metric called functional connectivity overlap ratio, we investigated connector hub alterations in Parkinson’s disease. Resting-state functional MRI data from 99 patients (male/female = 44/55) and 99 age- and sex-matched healthy controls (male/female = 39/60) participating in our cross-sectional study were used in the analysis. We have identified two sets of connector hubs, mainly located in the sensorimotor cortex and cerebellum, with significant connectivity alterations with multiple resting-state networks. Sensorimotor connector hubs have impaired connections primarily with primary processing (sensorimotor, visual), visuospatial, and basal ganglia networks, whereas cerebellar connector hubs have impaired connections with basal ganglia and executive control networks. These connectivity alterations correlated with patients’ motor symptoms. Specifically, values of the functional connectivity overlap ratio of the cerebellar connector hubs were associated with tremor score, whereas that of the sensorimotor connector hubs with postural instability and gait disturbance score, suggesting potential association of each set of connector hubs with the disorder’s two predominant forms, the akinesia/rigidity and resting tremor subtypes. In addition, values of the functional connectivity overlap ratio of the sensorimotor connector hubs were highly predictive in classifying patients from controls with an accuracy of 75.76%. These findings suggest that, together with the basal ganglia, cerebellar and sensorimotor connector hubs are significantly involved in Parkinson’s disease with their connectivity dysfunction potentially driving the clinical manifestations typically observed in this disorder.
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Affiliation(s)
- Epifanio Bagarinao
- Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine , Nagoya, Aichi, 461–8673 Japan
- Brain & Mind Research Center, Nagoya University , Nagoya, Aichi, 466–8550 Japan
| | - Kazuya Kawabata
- Brain & Mind Research Center, Nagoya University , Nagoya, Aichi, 466–8550 Japan
- Department of Neurology, Nagoya University Graduate School of Medicine , Nagoya, Aichi, 466-8550 Japan
| | - Hirohisa Watanabe
- Brain & Mind Research Center, Nagoya University , Nagoya, Aichi, 466–8550 Japan
- Department of Neurology, Nagoya University Graduate School of Medicine , Nagoya, Aichi, 466-8550 Japan
- Department of Neurology, Fujita Health University School of Medicine , Toyoake, Aichi, 470-1192 Japan
| | - Kazuhiro Hara
- Department of Neurology, Nagoya University Graduate School of Medicine , Nagoya, Aichi, 466-8550 Japan
| | - Reiko Ohdake
- Department of Neurology, Fujita Health University School of Medicine , Toyoake, Aichi, 470-1192 Japan
| | - Aya Ogura
- Brain & Mind Research Center, Nagoya University , Nagoya, Aichi, 466–8550 Japan
- Department of Neurology, Nagoya University Graduate School of Medicine , Nagoya, Aichi, 466-8550 Japan
| | - Michihito Masuda
- Department of Neurology, Nagoya University Graduate School of Medicine , Nagoya, Aichi, 466-8550 Japan
| | - Toshiyasu Kato
- Department of Neurology, Nagoya University Graduate School of Medicine , Nagoya, Aichi, 466-8550 Japan
| | - Satoshi Maesawa
- Brain & Mind Research Center, Nagoya University , Nagoya, Aichi, 466–8550 Japan
- Department of Neurosurgery, Nagoya University Graduate School of Medicine , Nagoya, Aichi, 466-8550 Japan
| | - Masahisa Katsuno
- Department of Neurology, Nagoya University Graduate School of Medicine , Nagoya, Aichi, 466-8550 Japan
| | - Gen Sobue
- Brain & Mind Research Center, Nagoya University , Nagoya, Aichi, 466–8550 Japan
- Aichi Medical University , Nagakute, Aichi, 480-1195 Japan
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20
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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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21
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Wen X, Chi S, Yu Y, Wang G, Zhang X, Wang Z, Gesang M, Luo B. The Cerebellum is Involved in Motor Improvements After Repetitive Transcranial Magnetic Stimulation in Parkinson's Disease Patients. Neuroscience 2022; 499:1-11. [PMID: 35817220 DOI: 10.1016/j.neuroscience.2022.07.004] [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: 03/18/2022] [Revised: 07/01/2022] [Accepted: 07/04/2022] [Indexed: 10/17/2022]
Abstract
Accumulating evidence indicates that repetitive transcranial magnetic stimulation (rTMS) ameliorates motor symptoms in patients with Parkinson's disease (PD); however, patients' responses to rTMS are different. Here, we aimed to explore neural activity changes in patients with PD exhibiting different responses to high-frequency rTMS treatments using functional magnetic resonance imaging (fMRI). We treated 24 patients with PD using 10-session rTMS (10 Hz) over the supplementary motor area (SMA) for 10 days. Resting-state functional magnetic resonance imaging (rs-fMRI), the Unified Parkinson's Disease Rating Scale Part III (UPDRS-III) and other neuropsychological scales were performed at the baseline and endpoint of rTMS treatment. The changes in the fractional amplitude of low-frequency fluctuation (fALFF) were calculated. Significant improvements were observed in motor symptoms, especially in the sub-symptoms of bradykinesia. All the participants were subsequently stratified into responders and non-responders according to the UPDRS-III reduction. We identified increased fALFF values in the left Crus II of the cerebellar hemisphere and bilateral thalamus as responsive signs to rTMS. Furthermore, the motor response to rTMS over the SMA, measured by the reduction in UPDRS-III and bradykinesia scores, was positively associated with increased fALFF values in the left Crus2 of cerebellar hemisphere, left lobule VIIB of cerebellar hemisphere, right lobule VI of the cerebellar hemisphere, and the right postcentral gyrus. These findings provide evidence for the involvement of cerebellar activity in the motor response to rTMS treatment.
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Affiliation(s)
- Xinrui Wen
- Department of Neurology & Brain Medical Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shumei Chi
- Department of Neurology, Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
| | - Yang Yu
- Department of Physical Medicine and Rehabilitation of the Affiliated Sir Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Guanjun Wang
- Department of Radiology, Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaoying Zhang
- Department of Neurology, Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zheng Wang
- Department of Neurology, Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Meiduo Gesang
- Department of Neurology, Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Benyan Luo
- Department of Neurology & Brain Medical Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
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22
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Revuelta GJ, Embry A, Elm JJ, Jenkins S, Lee P, Kautz S. A feasibility study of objective outcome measures used in clinical trials of freezing of gait. Pilot Feasibility Stud 2022; 8:137. [PMID: 35787816 PMCID: PMC9252072 DOI: 10.1186/s40814-022-01092-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 06/15/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Freezing of gait (FOG) is notoriously difficult to quantify, which has led to the use of multiple markers as outcomes for clinical trials. The instrumented timed up and go (TUG) and the many parameters that can be derived from it are commonly used as objective markers of FOG severity in clinical trials; however, it is unknown if they represent actual FOG severity. OBJECTIVE To determine the specificity and responsiveness of objective surrogate markers of FOG severity commonly utilized in FOG studies. METHODS Study design: We compared the specificity and responsiveness of commonly used markers in FOG clinical trials. Markers compared included velocity, step/stride length, step/stride length variability, TUG, and turn duration. Data was collected in four conditions (ON and OFF dopaminergic drugs, with and without a dual task). Unified Parkinson's Disease Rating Scale (UPDRS) was administered in the ON and OFF states. RESULTS Thirty-three subjects were recruited (17 PD subjects without FOG (PD-control) and 16 subjects with PD and dopa-responsive FOG PD-FOG). The UPDRS motor scores were 24.9 for the PD-control group in the ON state, 24.8 for the FOG group in the ON state, and 42.4 for the FOG group in the OFF state. Significant mean differences between the ON and OFF conditions were observed with all surrogate markers (p < 0.01). However, only dual task turn duration and step variability showed trends toward significance when comparing PD-control and ON-FOG (p = 0.08). Test-retest reliability was high (ICC > 0.90) for all markers except standard deviations. Step length variability was the only marker to show an area under the ROC curve analysis > 0.70 comparing ON-FOG vs. PD-control. CONCLUSIONS Multiple candidate surrogate markers for FOG severity showed responsiveness to levodopa challenge; however, most were not specific for FOG severity.
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Affiliation(s)
- Gonzalo J Revuelta
- Movement Disorders Division, Department of Neurology, College of Medicine, Medical University of South Carolina, 208B Rutledge Avenue, MSC 108, Charleston, SC, 29425, USA.
- Ralph H. Johnson VA Medical Center, Charleston, SC, USA.
| | - Aaron Embry
- Ralph H. Johnson VA Medical Center, Charleston, SC, USA
- Center for Rehabilitation Research in Neurological Conditions, Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| | - Jordan J Elm
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Shonna Jenkins
- Movement Disorders Division, Department of Neurology, College of Medicine, Medical University of South Carolina, 208B Rutledge Avenue, MSC 108, Charleston, SC, 29425, USA
| | - Philip Lee
- Movement Disorders Division, Department of Neurology, College of Medicine, Medical University of South Carolina, 208B Rutledge Avenue, MSC 108, Charleston, SC, 29425, USA
- Department of Neurology, Virginia Commonwealth University, Richmond, VA, USA
| | - Steve Kautz
- Ralph H. Johnson VA Medical Center, Charleston, SC, USA
- Center for Rehabilitation Research in Neurological Conditions, Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
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23
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Allen NE, Canning CG, Almeida LRS, Bloem BR, Keus SH, Löfgren N, Nieuwboer A, Verheyden GS, Yamato TP, Sherrington C. Interventions for preventing falls in Parkinson's disease. Cochrane Database Syst Rev 2022; 6:CD011574. [PMID: 35665915 PMCID: PMC9169540 DOI: 10.1002/14651858.cd011574.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Most people with Parkinson's disease (PD) experience at least one fall during the course of their disease. Several interventions designed to reduce falls have been studied. An up-to-date synthesis of evidence for interventions to reduce falls in people with PD will assist with informed decisions regarding fall-prevention interventions for people with PD. OBJECTIVES To assess the effects of interventions designed to reduce falls in people with PD. SEARCH METHODS CENTRAL, MEDLINE, Embase, four other databases and two trials registers were searched on 16 July 2020, together with reference checking, citation searching and contact with study authors to identify additional studies. We also conducted a top-up search on 13 October 2021. SELECTION CRITERIA We included randomised controlled trials (RCTs) of interventions that aimed to reduce falls in people with PD and reported the effect on falls. We excluded interventions that aimed to reduce falls due to syncope. DATA COLLECTION AND ANALYSIS We used standard Cochrane Review procedures. Primary outcomes were rate of falls and number of people who fell at least once. Secondary outcomes were the number of people sustaining one or more fall-related fractures, quality of life, adverse events and economic outcomes. The certainty of the evidence was assessed using GRADE. MAIN RESULTS This review includes 32 studies with 3370 participants randomised. We included 25 studies of exercise interventions (2700 participants), three studies of medication interventions (242 participants), one study of fall-prevention education (53 participants) and three studies of exercise plus education (375 participants). Overall, participants in the exercise trials and the exercise plus education trials had mild to moderate PD, while participants in the medication trials included those with more advanced disease. All studies had a high or unclear risk of bias in one or more items. Illustrative risks demonstrating the absolute impact of each intervention are presented in the summary of findings tables. Twelve studies compared exercise (all types) with a control intervention (an intervention not thought to reduce falls, such as usual care or sham exercise) in people with mild to moderate PD. Exercise probably reduces the rate of falls by 26% (rate ratio (RaR) 0.74, 95% confidence interval (CI) 0.63 to 0.87; 1456 participants, 12 studies; moderate-certainty evidence). Exercise probably slightly reduces the number of people experiencing one or more falls by 10% (risk ratio (RR) 0.90, 95% CI 0.80 to 1.00; 932 participants, 9 studies; moderate-certainty evidence). We are uncertain whether exercise makes little or no difference to the number of people experiencing one or more fall-related fractures (RR 0.57, 95% CI 0.28 to 1.17; 989 participants, 5 studies; very low-certainty evidence). Exercise may slightly improve health-related quality of life immediately following the intervention (standardised mean difference (SMD) -0.17, 95% CI -0.36 to 0.01; 951 participants, 5 studies; low-certainty evidence). We are uncertain whether exercise has an effect on adverse events or whether exercise is a cost-effective intervention for fall prevention. Three studies trialled a cholinesterase inhibitor (rivastigmine or donepezil). Cholinesterase inhibitors may reduce the rate of falls by 50% (RaR 0.50, 95% CI 0.44 to 0.58; 229 participants, 3 studies; low-certainty evidence). However, we are uncertain if this medication makes little or no difference to the number of people experiencing one or more falls (RR 1.01, 95% CI 0.90 to 1.14230 participants, 3 studies) and to health-related quality of life (EQ5D Thermometer mean difference (MD) 3.00, 95% CI -3.06 to 9.06; very low-certainty evidence). Cholinesterase inhibitors may increase the rate of non fall-related adverse events by 60% (RaR 1.60, 95% CI 1.28 to 2.01; 175 participants, 2 studies; low-certainty evidence). Most adverse events were mild and transient in nature. No data was available regarding the cost-effectiveness of medication for fall prevention. We are uncertain of the effect of education compared to a control intervention on the number of people who fell at least once (RR 10.89, 95% CI 1.26 to 94.03; 53 participants, 1 study; very low-certainty evidence), and no data were available for the other outcomes of interest for this comparisonWe are also uncertain (very low-certainty evidence) whether exercise combined with education makes little or no difference to the number of falls (RaR 0.46, 95% CI 0.12 to 1.85; 320 participants, 2 studies), the number of people sustaining fall-related fractures (RR 1.45, 95% CI 0.40 to 5.32,320 participants, 2 studies), or health-related quality of life (PDQ39 MD 0.05, 95% CI -3.12 to 3.23, 305 participants, 2 studies). Exercise plus education may make little or no difference to the number of people experiencing one or more falls (RR 0.89, 95% CI 0.75 to 1.07; 352 participants, 3 studies; low-certainty evidence). We are uncertain whether exercise combined with education has an effect on adverse events or is a cost-effective intervention for fall prevention. AUTHORS' CONCLUSIONS: Exercise interventions probably reduce the rate of falls, and probably slightly reduce the number of people falling in people with mild to moderate PD. Cholinesterase inhibitors may reduce the rate of falls, but we are uncertain if they have an effect on the number of people falling. The decision to use these medications needs to be balanced against the risk of non fall-related adverse events, though these adverse events were predominantly mild or transient in nature. Further research in the form of large, high-quality RCTs are required to determine the relative impact of different types of exercise and different levels of supervision on falls, and how this could be influenced by disease severity. Further work is also needed to increase the certainty of the effects of medication and further explore falls prevention education interventions both delivered alone and in combination with exercise.
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Affiliation(s)
- Natalie E Allen
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Colleen G Canning
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Lorena Rosa S Almeida
- Movement Disorders and Parkinson's Disease Clinic, Roberto Santos General Hospital, Salvador, Brazil
- Motor Behavior and Neurorehabilitation Research Group, Bahiana School of Medicine and Public Health, Salvador, Brazil
| | - Bastiaan R Bloem
- Raboud University Medical Centre; Donders Institute for Brain, Cognition and Behaviour; Department of Neurology, Centre of Expertise for Parkinson & Movement Disorders, Nijmegen, Netherlands
| | - Samyra Hj Keus
- Department of Neurology, Radboud University Nijmegen Medical Center, Nijmegen, Netherlands
- Quality and Improvement, OLVG, Amsterdam, Netherlands
| | - Niklas Löfgren
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Department of Women's and Children's Health, Physiotherapy, Uppsala University, Uppsala, Sweden
| | - Alice Nieuwboer
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | | | - Tiê P Yamato
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
| | - Catherine Sherrington
- Institute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Yang H, Liu WV, Wang S, Yang W, Liu C, Wen Z, Hu L, Guo J, Fan G, Luo X, Zha Y. Freezing of Gait in Multiple System Atrophy. Front Aging Neurosci 2022; 14:833287. [PMID: 35462702 PMCID: PMC9024348 DOI: 10.3389/fnagi.2022.833287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 03/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background and PurposeFreezing of gait (FOG) is a common gait disturbance phenomenon in multiple system atrophy (MSA) patients. The current investigation assessed the incidence FOG in a cross-sectional clinical study, and clinical correlations associated with it.MethodsNinety-nine MSA patients from three hospitals in China were consecutively enrolled in the study. Eight patients were subsequently excluded from the analysis due to incomplete information. The prevalence of FOG symptoms in the MSA cohort was determined, and clinical manifestations in MSA patients with and without FOG were assessed.ResultsOf 91 MSA patients, 60 (65.93%) exhibited FOG. The incidence of FOG increased with disease duration and motor severity and was correlated with modified Hoehn and Yahr (H-Y) stages [odds ratio (OR), 0.54; 95% confidence interval (CI), 0.33–3.92], longer disease duration (OR, 0.54, 95% CI, 0.37–0.78), higher Unified Multiple System Atrophy Rating Scale (UMSARS) score (OR, 0.96, 95% CI, 0.93–0.99), MSA-cerebellum subtype (OR, 2.99, 95% CI, 1.22–7.33), levodopa-equivalent dose (LDED) (OR, 0.998, 95% CI, 0.997–1.00), and higher Scale for the Assessment and Rating of Ataxia (SARA) score (OR, 0.80, 95% CI, 0.72–0.89) (logistic regression). Motor dysfunction was significantly positively associated with lower quality of life scores (p < 0.01).ConclusionFOG is a common symptom in MSA patients and it is correlated with poor quality of life, disease progression and severity, levodopa-equivalent dose, and cerebellum impairment.
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Affiliation(s)
- Huaguang Yang
- Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, China
| | | | - Shanshan Wang
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Wenbin Yang
- Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Changsheng Liu
- Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zhi Wen
- Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Lanhua Hu
- Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jinxia Guo
- MR Research, GE Healthcare, Beijing, China
| | - Guoguang Fan
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Xiaoguang Luo
- Department of Neurology, The First Affiliated Hospital of South University of Science and Technology, The Second Clinical Medical College of Jinan University, Shenzhen People’s Hospital, Shenzhen, China
- *Correspondence: Xiaoguang Luo,
| | - Yunfei Zha
- Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, China
- Yunfei Zha,
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25
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Fujikawa J, Morigaki R, Yamamoto N, Oda T, Nakanishi H, Izumi Y, Takagi Y. Therapeutic Devices for Motor Symptoms in Parkinson’s Disease: Current Progress and a Systematic Review of Recent Randomized Controlled Trials. Front Aging Neurosci 2022; 14:807909. [PMID: 35462692 PMCID: PMC9020378 DOI: 10.3389/fnagi.2022.807909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 01/14/2022] [Indexed: 11/29/2022] Open
Abstract
Background Pharmacotherapy is the first-line treatment option for Parkinson’s disease, and levodopa is considered the most effective drug for managing motor symptoms. However, side effects such as motor fluctuation and dyskinesia have been associated with levodopa treatment. For these conditions, alternative therapies, including invasive and non-invasive medical devices, may be helpful. This review sheds light on current progress in the development of devices to alleviate motor symptoms in Parkinson’s disease. Methods We first conducted a narrative literature review to obtain an overview of current invasive and non-invasive medical devices and thereafter performed a systematic review of recent randomized controlled trials (RCTs) of these devices. Results Our review revealed different characteristics of each device and their effectiveness for motor symptoms. Although invasive medical devices are usually highly effective, surgical procedures can be burdensome for patients and have serious side effects. In contrast, non-pharmacological/non-surgical devices have fewer complications. RCTs of non-invasive devices, especially non-invasive brain stimulation and mechanical peripheral stimulation devices, have proven effectiveness on motor symptoms. Nearly no non-invasive devices have yet received Food and Drug Administration certification or a CE mark. Conclusion Invasive and non-invasive medical devices have unique characteristics, and several RCTs have been conducted for each device. Invasive devices are more effective, while non-invasive devices are less effective and have lower hurdles and risks. It is important to understand the characteristics of each device and capitalize on these.
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Affiliation(s)
- Joji Fujikawa
- Department of Advanced Brain Research, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima, Japan
| | - Ryoma Morigaki
- Department of Advanced Brain Research, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima, Japan
- Department of Neurosurgery, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima, Japan
- *Correspondence: Ryoma Morigaki,
| | - Nobuaki Yamamoto
- Department of Advanced Brain Research, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima, Japan
- Department of Neurology, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima, Japan
| | - Teruo Oda
- Department of Advanced Brain Research, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima, Japan
| | - Hiroshi Nakanishi
- Department of Neurosurgery, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima, Japan
| | - Yuishin Izumi
- Department of Neurology, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima, Japan
| | - Yasushi Takagi
- Department of Advanced Brain Research, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima, Japan
- Department of Neurosurgery, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima, Japan
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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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27
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Pateraki G, Anargyros K, Aloizou AM, Siokas V, Bakirtzis C, Liampas I, Tsouris Z, Ziogka P, Sgantzos M, Folia V, Peristeri E, Dardiotis E. Therapeutic application of rTMS in neurodegenerative and movement disorders: A review. J Electromyogr Kinesiol 2021; 62:102622. [PMID: 34890834 DOI: 10.1016/j.jelekin.2021.102622] [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] [Received: 04/12/2021] [Revised: 11/08/2021] [Accepted: 11/22/2021] [Indexed: 12/11/2022] Open
Abstract
Transcranial magnetic stimulation (TMS) is a non-invasive form of brain stimulation that makes use of the magnetic field generated when an electric current passes through a magnetic coil placed over the scalp. It can be applied as a single stimulus at a time, in pairs of stimuli, or repetitively in trains of stimuli (repetitive TMS, rTMS). RTMS can induce changes in brain activity, whose after-effects reflect the processes of long-term potentiation and long-term depression, as certain protocols, namely those using low frequencies (≤1 Hz) seem to suppress cortical excitability, while those using high frequencies (>1 Hz) seem to enhance it. It is a technique with very few and mostly mild side-effects, whose effects can persist for long time periods, and as such, it has been studied as a potential treatment option in a multitude of neurodegenerative diseases, including those affecting movement. Although rTMS has received approval as a treatment strategy of only a few aspects in movement disorders in the latest guidelines, its further use seems to also be promising in their context. In this review, we gathered the available literature on the therapeutic application of rTMS in movement disorders, namely Parkinson's disease, Amyotrophic Lateral Sclerosis, Huntington's disease, Dystonia, Tic disorders and Essential Tremor.
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Affiliation(s)
- Georgia Pateraki
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Konstantinos Anargyros
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Athina-Maria Aloizou
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Vasileios Siokas
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Christos Bakirtzis
- B' Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Liampas
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Zisis Tsouris
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Pinelopi Ziogka
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Markos Sgantzos
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Vasiliki Folia
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Eleni Peristeri
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Efthimios Dardiotis
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece.
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28
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Karimi F, Niu J, Gouweleeuw K, Almeida Q, Jiang N. Movement-related EEG signatures associated with freezing of gait in Parkinson's disease: an integrative analysis. Brain Commun 2021; 3:fcab277. [PMID: 34877535 PMCID: PMC8643573 DOI: 10.1093/braincomms/fcab277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 08/20/2021] [Accepted: 09/28/2021] [Indexed: 01/09/2023] Open
Abstract
Freezing of gait is the most severe gait deficit associated with Parkinson's disease and significantly affects patients' independence and consequently their quality of life. The lack of a clear understanding of its underlying neurophysiological mechanism has resulted in limited effectiveness of the current treatment options. In this study, we investigated EEG features over (pre-)supplementary motor area and primary motor cortex during a simple cue-based ankle dorsiflexion movement. These features include movement-related cortical potentials (0.05-5 Hz) and brain oscillations (1-50 Hz). Electromyogram signal from the tibialis anterior muscle of the dominant foot was used to determine the movement onset. The EEG features before, during and following the onset of the movement were compared among three groups of participants: patients with freezing (N = 14, 11 males), patients without freezing (N = 14, 13 males) and healthy age-matched controls (N = 13, 10 males) with 15 recorded trials for each individual. Additionally, Parkinson's disease patients with freezing of gait were separated into mild (N = 7) and severe cases (N = 5), so that EEG features associated with freezing severity could be investigated. The results indicated significant differences between patients with severe freezing of gait compared to healthy controls and patients without freezing of gait. In addition, patients with mild and severe freezing represented cortical activity differences. For patients with freezing, the initial component of movement-related cortical potential is significantly lower than that of the healthy controls (P = 0.002) and is affected by the severity of freezing. Furthermore, a striking absence of beta frequency band (12-35 Hz) desynchronization was observed in patients with freezing, especially low-beta frequency band over Cz, before the movement, which was also associated with the severity of the freezing of gait. Low-beta (13-20 Hz) and high-beta (21-35 Hz) frequency band activities represented unique features for each group. Beta event-related desynchronization over Cz present in healthy controls prior to movement onset, was partially replaced by the theta band (4-8 Hz) synchrony in patients with freezing. Patients with severe freezing also represented some level of theta band synchronization over contralateral supplementary motor area. This suggests the involvement of cognitive processing over the motor cortex in controlling cue-based voluntary movement as a compensatory mechanism associated with freezing of gait. The EEG features identified in this study are indicative of important freezing of gait clinical characteristics such as severity and contribute to a better understanding of the underlying neurophysiology of the mysterious phenomenon of freezing of gait.
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Affiliation(s)
- Fatemeh Karimi
- Systems Design Engineering Department, University of Waterloo, Waterloo N2L 3G1, Canada
| | - Jiansheng Niu
- Systems Design Engineering Department, University of Waterloo, Waterloo N2L 3G1, Canada
| | - Kim Gouweleeuw
- Department of Human Media Interaction, University of Twente, 7522 NB Enschede, The Netherlands
| | - Quincy Almeida
- Department of Kinesiology and Physical Education, Wilfrid Laurier University, Waterloo N2L 3C5, Canada
| | - Ning Jiang
- Systems Design Engineering Department, University of Waterloo, Waterloo N2L 3G1, Canada
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29
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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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30
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Godeiro C, França C, Carra RB, Saba F, Saba R, Maia D, Brandão P, Allam N, Rieder CRM, Freitas FC, Capato T, Spitz M, Faria DDD, Cordellini M, Veiga BAAG, Rocha MSG, Maciel R, Melo LBD, Möller PDS, R R Júnior M, Fornari LHT, Mantese CE, Barbosa ER, Munhoz RP, Coletta MVD, Cury RG. Use of non-invasive stimulation in movement disorders: a critical review. ARQUIVOS DE NEURO-PSIQUIATRIA 2021; 79:630-646. [PMID: 34468499 DOI: 10.1590/0004-282x-anp-2020-0381] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 10/21/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Noninvasive stimulation has been widely used in the past 30 years to study and treat a large number of neurological diseases, including movement disorders. OBJECTIVE In this critical review, we illustrate the rationale for use of these techniques in movement disorders and summarize the best medical evidence based on the main clinical trials performed to date. METHODS A nationally representative group of experts performed a comprehensive review of the literature in order to analyze the key clinical decision-making factors driving transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) in movement disorders. Classes of evidence and recommendations were described for each disease. RESULTS Despite unavoidable heterogeneities and low effect size, TMS is likely to be effective for treating motor symptoms and depression in Parkinson's disease (PD). The efficacy in other movement disorders is unclear. TMS is possibly effective for focal hand dystonia, essential tremor and cerebellar ataxia. Additionally, it is likely to be ineffective in reducing tics in Tourette syndrome. Lastly, tDCS is likely to be effective in improving gait in PD. CONCLUSIONS There is encouraging evidence for the use of noninvasive stimulation on a subset of symptoms in selected movement disorders, although the means to optimize protocols for improving positive outcomes in routine clinical practice remain undetermined. Similarly, the best stimulation paradigms and responder profile need to be investigated in large clinical trials with established therapeutic and assessment paradigms that could also allow genuine long-term benefits to be determined.
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Affiliation(s)
- Clecio Godeiro
- Universidade Federal do Rio Grande do Norte, Departamento de Medicina Integrada, Natal RN, Brazil
| | - Carina França
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, Centro de Distúrbios do Movimento, São Paulo SP, Brazil
| | - Rafael Bernhart Carra
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, Centro de Distúrbios do Movimento, São Paulo SP, Brazil
| | - Felipe Saba
- Universidade Estadual de Campinas, São Paulo SP, Brazil
| | - Roberta Saba
- Hospital do Servidor Público Estadual, São Paulo SP, Brazil.,Universidade Federal de São Paulo, São Paulo SP, Brazil
| | - Débora Maia
- Universidade Federal de Minas Gerais, Departamento de Medicina Interna, Unidade de Distúrbios do Movimento, Belo Horizonte MG, Brazil
| | - Pedro Brandão
- Universidade de Brasília, Laboratório de Neurociências e Comportamento, Brasília DF, Brazil
| | - Nasser Allam
- Universidade de Brasília, Laboratório de Neurociências e Comportamento, Brasília DF, Brazil
| | - Carlos R M Rieder
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre RS, Brazil
| | | | - Tamine Capato
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, Centro de Distúrbios do Movimento, São Paulo SP, Brazil.,Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Nijmegen, Netherlands
| | - Mariana Spitz
- Universidade do Estado do Rio de Janeiro, Unidade de Distúrbios do Movimento, Rio de Janeiro RJ, Brazil
| | - Danilo Donizete de Faria
- Hospital do Servidor Público Estadual, São Paulo SP, Brazil.,Universidade Federal de São Paulo, São Paulo SP, Brazil
| | | | | | - Maria Sheila G Rocha
- Hospital Santa Marcelina, Departamento de Neurologia e Neurocirurgia Funcional, São Paulo SP, Brazil
| | - Ricardo Maciel
- Universidade Federal de Minas Gerais, Departamento de Medicina Interna, Unidade de Distúrbios do Movimento, Belo Horizonte MG, Brazil
| | - Lucio B De Melo
- Universidade Estadual de Londrina, Serviço de Neurologia, Londrina PR, Brazil
| | - Patricia D S Möller
- Hospital da Criança de Brasília José Alencar, Unidade Pediátrica de Distúrbios do Movimento, Brasília DF, Brazil
| | - Magno R R Júnior
- Universidade Federal do Maranhão, Hospital Universitário, São Luís MA, Brazil
| | - Luís H T Fornari
- Santa Casa de Misericórdia de Porto Alegre, Departamento de Neurologia, Porto Alegre RS, Brazil
| | - Carlos E Mantese
- Hospital Mãe de Deus, Serviço de Neurologia, Porto Alegre RS, Brazil
| | - Egberto Reis Barbosa
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, Centro de Distúrbios do Movimento, São Paulo SP, Brazil
| | - Renato P Munhoz
- University of Toronto, Toronto Western Hospital - UHN, Division of Neurology, Morton and Gloria Shulman Movement Disorders Centre and Edmond J. Safra Program in Parkinson's Disease, Toronto ON, Canada.,Krembil Brain Institute, Toronto ON, Canada
| | | | - Rubens Gisbert Cury
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, Centro de Distúrbios do Movimento, São Paulo SP, Brazil
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31
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Use of machine learning method on automatic classification of motor subtype of Parkinson's disease based on multilevel indices of rs-fMRI. Parkinsonism Relat Disord 2021; 90:65-72. [PMID: 34399160 DOI: 10.1016/j.parkreldis.2021.08.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 07/20/2021] [Accepted: 08/09/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This study aimed to develop an automatic classifier to distinguish different motor subtypes of Parkinson's disease (PD) based on multilevel indices of resting-state functional magnetic resonance imaging (rs-fMRI). METHODS Ninety-six PD patients, which included thirty-nine postural instability and gait difficulty (PIGD) subtype and fifty-seven tremor-dominant (TD) subtype, were enrolled and allocated to training and validation datasets with a ratio of 7:3. A total of five types of index, consisting of mean regional homogeneity (mReHo), mean amplitude of low-frequency fluctuation (mALFF), degree of centrality (DC), voxel-mirrored homotopic connectivity (VMHC), and functional connectivity (FC), were extracted. The features were then selected using a two-sample t-test, the least absolute shrinkage and selection operator (LASSO), and Spearman's rank correlation coefficient. Finally, support vector machine (SVM) models based on the separate index and multilevel indices were built, and the performance of models was assessed via the area under the receiver operating characteristic curve (AUC). Feature importance was evaluated using Shapley additive explanation (SHAP) values. RESULTS The optimal SVM model was obtained based on multilevel rs-fMRI indices, with an AUC of 0.934 in the training dataset and an AUC of 0.917 in the validation dataset. The AUCs of the models based on the separate index were ranged from 0.783 to 0.858 for the training dataset and from 0.713 to 0.792 for the validation dataset. SHAP analysis revealed that functional activity and connectivity in frontal lobe and cerebellum were important features for differentiating PD subtypes. CONCLUSIONS Our findings demonstrated multilevel rs-fMRI indices could provide more comprehensive information on brain functionalteration. Furthermore, the machine learning method based on multilevel rs-fMRI indices might be served as an alternative approach for automatically classifying clinical subtypes in PD at the individual level.
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32
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Rahimpour S, Gaztanaga W, Yadav AP, Chang SJ, Krucoff MO, Cajigas I, Turner DA, Wang DD. Freezing of Gait in Parkinson's Disease: Invasive and Noninvasive Neuromodulation. Neuromodulation 2021; 24:829-842. [PMID: 33368872 PMCID: PMC8233405 DOI: 10.1111/ner.13347] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/01/2020] [Accepted: 12/01/2020] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Freezing of gait (FoG) is one of the most disabling yet poorly understood symptoms of Parkinson's disease (PD). FoG is an episodic gait pattern characterized by the inability to step that occurs on initiation or turning while walking, particularly with perception of tight surroundings. This phenomenon impairs balance, increases falls, and reduces the quality of life. MATERIALS AND METHODS Clinical-anatomical correlations, electrophysiology, and functional imaging have generated several mechanistic hypotheses, ranging from the most distal (abnormal central pattern generators of the spinal cord) to the most proximal (frontal executive dysfunction). Here, we review the neuroanatomy and pathophysiology of gait initiation in the context of FoG, and we discuss targets of central nervous system neuromodulation and their outcomes so far. The PubMed database was searched using these key words: neuromodulation, freezing of gait, Parkinson's disease, and gait disorders. CONCLUSION Despite these investigations, the pathogenesis of this process remains poorly understood. The evidence presented in this review suggests FoG to be a heterogenous phenomenon without a single unifying pathologic target. Future studies rigorously assessing targets as well as multimodal approaches will be essential to define the next generation of therapeutic treatments.
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Affiliation(s)
- Shervin Rahimpour
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Wendy Gaztanaga
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Amol P. Yadav
- Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
- Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Stephano J. Chang
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Max O. Krucoff
- Department of Neurosurgery, Medical College of Wisconsin, Wauwatosa, WI, USA
- Department of Biomedical Engineering, Marquette University & Medical College of Wisconsin, Milwaukee, WI, USA
| | - Iahn Cajigas
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Dennis A. Turner
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
- Departments of Neurobiology and Biomedical Engineering, Duke University, Durham, NC, USA
| | - Doris D. Wang
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
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33
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Potvin-Desrochers A, Paquette C. Potential Non-invasive Brain Stimulation Targets to Alleviate Freezing of Gait in Parkinson's Disease. Neuroscience 2021; 468:366-376. [PMID: 34102265 DOI: 10.1016/j.neuroscience.2021.05.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 05/14/2021] [Accepted: 05/31/2021] [Indexed: 11/15/2022]
Abstract
Freezing of gait (FOG) is a common motor symptom in Parkinson's disease (PD). Although FOG reduces quality of life, affects mobility and increases the risk of falls, there are little to no effective treatments to alleviate FOG. Non-invasive brain stimulation (NIBS) has recently yielded attention as a potential treatment to reduce FOG symptoms however, stimulation parameters and protocols remain inconsistent and require further research. Specifically, targets for stimulation require careful review. Thus, with current neuroimaging and neuro-electrophysiological evidence, we consider potential cortical targets thought to be involved in the pathophysiology of FOG according to the Interference model, and within reach of NIBS. We note that the primary motor cortex, the supplementary motor area and the dorsolateral prefrontal cortex have already drawn attention as NIBS targets for FOG, but based on neuroimaging evidence the premotor cortex, the medial prefrontal cortex, the cerebellum, and more particularly, the posterior parietal cortex should be considered as potential regions for stimulation. We also discuss different methodological considerations, such as stimulation type, medication state, and hemisphere to target, and future perspectives for NIBS protocols in FOG.
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Affiliation(s)
- Alexandra Potvin-Desrochers
- Department of Kinesiology and Physical Education, Currie Gymnasium, 475 Pine Avenue West, McGill University, Montréal, Québec H2W 1S4, Canada; Integrated Program in Neuroscience, Montreal Neurological Institute, 3801 University Street, McGill University, Montréal, Québec H3A 2B4, Canada; Centre for Interdisciplinary Research in Rehabilitation (Jewish Rehabilitation Hospital Research Site and CISSS Laval), 3205 Place Alton-Goldbloom, Laval, Québec H7V 1R2, Canada
| | - Caroline Paquette
- Department of Kinesiology and Physical Education, Currie Gymnasium, 475 Pine Avenue West, McGill University, Montréal, Québec H2W 1S4, Canada; Integrated Program in Neuroscience, Montreal Neurological Institute, 3801 University Street, McGill University, Montréal, Québec H3A 2B4, Canada; Centre for Interdisciplinary Research in Rehabilitation (Jewish Rehabilitation Hospital Research Site and CISSS Laval), 3205 Place Alton-Goldbloom, Laval, Québec H7V 1R2, Canada.
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34
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Paired inhibitory stimulation and gait training modulates supplemental motor area connectivity in freezing of gait. Parkinsonism Relat Disord 2021; 88:28-33. [PMID: 34102418 DOI: 10.1016/j.parkreldis.2021.05.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 05/11/2021] [Accepted: 05/26/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Freezing of gait (FOG) is a debilitating feature of Parkinson's disease (PD). Evidence suggests patients with FOG have increased cortical control of gait. The supplementary motor area (SMA) may be a key structure due to its connectivity with locomotor and cognitive networks. The objectives of this study were to determine (1) if SMA connectivity is disrupted in patients with FOG and (2) if "inhibitory" repetitive transcranial magnetic stimulation can decrease maladaptive SMA connectivity. METHODS Two experiments were performed. In experiment 1 resting-state (T2* BOLD imaging) was compared between 38 PD freezers and 17 PD controls. In experiment 2, twenty PD patients with FOG were randomized to either 10 sessions of real or sham rTMS to the SMA (1 Hz, 110% motor threshold, 1200 pulses/session) combined with daily gait training. RESULTS (Experiment 1) Freezers had increased connectivity between the left SMA and the vermis of the cerebellum and decreased connectivity between the SMA and the orbitofrontal cortex (pFDR-corr <0.05). (Experiment 2) 10 sessions of active TMS reduced SMA connectivity with the anterior cingulate, angular gyrus and the medial temporal cortex, whereas sham TMS did not reduce SMA connectivity. From a behavioral perspective, both groups showed nFOG-Q improvements (F(4, 25.7) = 3.87, p = 0.014). CONCLUSIONS The SMA in freezers is hyper-connected to the cerebellum, a key locomotor region which may represent maladaptive compensation. In this preliminary study, 1 Hz rTMS reduced SMA connectivity however, this was not specific to the locomotor regions. Intervention outcomes may be improved with subject specific targeting of SMA.
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35
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Grassi G, Albani G, Terenzi F, Razzolini L, Ramat S. New pharmacological and neuromodulation approaches for impulsive-compulsive behaviors in Parkinson's disease. Neurol Sci 2021; 42:2673-2682. [PMID: 33852081 DOI: 10.1007/s10072-021-05237-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 04/07/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION A significant proportion of patients with Parkinson's disease (PD) display a set of impulsive-compulsive behaviors at some point during the course of illness. These behaviors range from the so-called behavioral addictions to dopamine dysregulation syndrome, punding and hoarding disorders. These behaviors have been consistently linked to the use of dopaminergic medications used to treat PD motor symptoms (dopamine agonists, levodopa, and other agents) and less consistently to neuromodulation techniques such as deep brain stimulation (DBS). Since there are still no approved treatments for these conditions, their pharmacological management is still a big challenge for clinicians. METHODS We conducted an extensive review of current pharmacological and neuromodulation literature for the management of impulsive-compulsive disorders in PD patients. RESULTS Pharmacological treatment approaches for impulsive-compulsive behaviors and DDS in PD patients include reduction of levodopa (LD), reduction/cessation of dopamine agonist (DA), and initiation of infusion therapies (apomorphine infusion and duodopa). Also, atomoxetine, a noradrenergic agent approved for the treatment of attention deficit hyperactivity disorder, showed some interesting preliminary results but there is still a lack of controlled longitudinal studies. Finally, while DBS effects on impulsive-compulsive disorders are still controversial, non-invasive techniques (such as transcranial magnetic stimulation and transcranial direct current stimulation) could have a potential positive effect but, again, there is still a lack of controlled trials. CONCLUSION Managing impulsivity and compulsivity in PD patients is still a non-evidence-based challenge for clinicians. Controlled trials on promising approaches such as atomoxetine and non-invasive neuromodulation techniques are needed.
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Affiliation(s)
- Giacomo Grassi
- Brain Center Firenze, Viale Belfiore 36, 5014, Florence, Italy.
| | | | | | - Lorenzo Razzolini
- Brain Center Firenze, Viale Belfiore 36, 5014, Florence, Italy.,University of Florence, Florence, Italy
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36
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Facilitatory rTMS over the Supplementary Motor Cortex Impedes Gait Performance in Parkinson Patients with Freezing of Gait. Brain Sci 2021; 11:brainsci11030321. [PMID: 33802532 PMCID: PMC7999694 DOI: 10.3390/brainsci11030321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 11/17/2022] Open
Abstract
Freezing of gait (FOG) in Parkinson’s disease (PD) occurs frequently in situations with high environmental complexity. The supplementary motor cortex (SMC) is regarded as a major network node that exerts cortical input for motor control in these situations. We aimed at assessing the impact of single-session (excitatory) intermittent theta burst stimulation (iTBS) of the SMC on established walking during FOG provoking situations such as passing through narrow spaces and turning for directional changes. Twelve PD patients with FOG underwent two visits in the off-medication state with either iTBS or sham stimulation. At each visit, spatiotemporal gait parameters were measured during walking without obstacles and in FOG-provoking situations before and after stimulation. When patients passed through narrow spaces, decreased stride time along with increased stride length and walking speed (i.e., improved gait) was observed after both sham stimulation and iTBS. These effects, particularly on stride time, were attenuated by real iTBS. During turning, iTBS resulted in decreased stride time along with unchanged stride length, a constellation compatible with increased stepping frequency. The observed iTBS effects are regarded as relative gait deterioration. We conclude that iTBS over the SMC increases stepping frequency in PD patients with FOG, particularly in FOG provoking situations.
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Effects of whole-body vibration on motor function in patients with Parkinson’s disease: a systematic review and meta-analysis. BRAIN IMPAIR 2020. [DOI: 10.1017/brimp.2020.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjective:To review the effects of whole body vibration for patients with Parkinson’s disease.Design:Randomized clinical trials comparing whole body vibration with no vibration or conventional physical therapy for patients with Parkinson’s disease were searched up to July 31, 2019.Results:Seven studies with 196 patients were included for quantitative analysis. No significant difference was found between groups in motor score of unified Parkinson’s disease rating scale (UPDRS-III) (WMD [weighted mean difference] = −1.75, 95% CI, −5.40 to 1.90, I2 = 45.8%), functional reach test (SMD [standardized mean difference] = 0.21, 95% CI, −0.29 to 0.71; I2 = 0%), and other balance tests (including Berg balance test and Tinetti score) (SMD = 0.39, 95% CI, −0.01 to 0.80; I2 = 0%). No statistical difference was detected in walking velocity as well (WMD = −0.05, 95% CI, −0.17 to 0.06; I2 = 0%). In contrast, the pooled analysis from four studies on the Time Up and Go test showed favorable results for whole body vibration (WMD = −1.59, 95% CI, −2.90 to −0.28, I2 = 0%).Conclusion:Whole body vibration may not be beneficial over placebo or conventional physical therapy in overall motor function, balance, and walking velocity in patients with Parkinson’s disease. However, it might have positive effects on sit to stand transitions or turning.
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Li J, Mi TM, Zhu BF, Ma JH, Han C, Li Y, Yang WM, Chan P. High-frequency repetitive transcranial magnetic stimulation over the primary motor cortex relieves musculoskeletal pain in patients with Parkinson's disease: A randomized controlled trial. Parkinsonism Relat Disord 2020; 80:113-119. [DOI: 10.1016/j.parkreldis.2020.07.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 06/29/2020] [Accepted: 07/06/2020] [Indexed: 12/28/2022]
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Klucken J, Winkler J, Krüger R, Jost W. [The history of Freezing-of-gait in Parkinson's disease - from phenomena to symptom]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2020; 88:573-581. [PMID: 32957142 DOI: 10.1055/a-1227-6258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The background of the freezing-of-gait (FOG) phenomenon in Parkinson's syndrome is presented in this review. The following issues are addressed: characterization of the symptom freezing and its subtypes that challenge standardized diagnostic procedures; available assessment methods generating freezing-related parameters that not only support clinical studies but can also be applied in everyday care, and current therapy options. FOG exists in different subtypes, and clinical and diagnostic definitions are limited by subjective characterization and semi-standardized tests. FOG-specific drug options are not existing, apart from the optimization of dopaminergic medication, which may also be due to the poor discriminatory power of standardized diagnostics. This is also true for deep brain stimulation. Both of these therapeutic options may be due not only to the complex neural network alterations as a motor-control correlate of FOG, but also because of challenging diagnostic assessments methodologies. Innovative, wearable, sensor-based diagnostic strategies are currently being developed, and supportive therapies using tools and technologies focusing on 'cueing' are becoming increasingly well accepted. Even though high level evidence is missing, they provide a helpful treatment option for individualized therapy. It can be assumed that these options will become particularly popular due to technological progress and likely alter the everyday treatment challenges faced by doctors and therapists.
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Affiliation(s)
- Jochen Klucken
- Molekulare Neurologie, Universitätsklinikum Erlangen; Fraunhofer-Institut für Integrierte Schaltungen IIS, Erlangen; Medical Valley Digital Health Application Center, Bamberg
| | - Juergen Winkler
- Molekular-Neurologische Abteilung, Universitätsklinikum Erlangen
| | - Rejko Krüger
- Universite du Luxembourg, Clinical and Experimental Neuroscience; Luxembourg Institute for Health (LIH), Transversal Translational Medicine
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Mi TM, Garg S, Ba F, Liu AP, Liang PP, Gao LL, Jia Q, Xu EH, Li KC, Chan P, McKeown MJ. Repetitive transcranial magnetic stimulation improves Parkinson's freezing of gait via normalizing brain connectivity. NPJ Parkinsons Dis 2020; 6:16. [PMID: 32699818 PMCID: PMC7368045 DOI: 10.1038/s41531-020-0118-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 06/15/2020] [Indexed: 12/12/2022] Open
Abstract
Robust, effective treatments for Parkinson's freezing of gait remain elusive. Our previous study revealed beneficial effects of high-frequency rTMS over the supplementary motor area. The present study aims to explore the neural mechanisms of rTMS treatments utilizing novel exploratory multivariate approaches. We first conducted a resting-state functional MRI study with a group of 40 Parkinson's disease patients with freezing of gait, 31 without freezing of gait, and 30 normal controls. A subset of 30 patients with freezing of gait (verum group: N = 20; sham group: N = 10) who participated the aforementioned rTMS study underwent another scan after the treatments. Using the baseline scans, the imaging biomarkers for freezing of gait and Parkinson's disease were developed by contrasting the connectivity profiles of patients with freezing of gait to those without freezing of gait and normal controls, respectively. These two biomarkers were then interrogated to assess the rTMS effects on connectivity patterns. Results showed that the freezing of gait biomarker was negatively correlated with Freezing of Gait Questionnaire score (r = -0.6723, p < 0.0001); while the Parkinson's disease biomarker was negatively correlated with MDS-UPDRS motor score (r = -0.7281, p < 0.0001). After the rTMS treatment, both the freezing of gait biomarker (0.326 ± 0.125 vs. 0.486 ± 0.193, p = 0.0071) and Parkinson's disease biomarker (0.313 ± 0.126 vs. 0.379 ± 0.155, p = 0.0378) were significantly improved in the verum group; whereas no significant biomarker changes were found in the sham group. Our findings indicate that high-frequency rTMS over the supplementary motor area confers the beneficial effect jointly through normalizing abnormal brain functional connectivity patterns specifically associated with freezing of gait, in addition to normalizing overall disrupted connectivity patterns seen in Parkinson's disease.
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Affiliation(s)
- Tao-Mian Mi
- Department of Neurology, Neurobiology and Geriatrics, Xuanwu Hospital of Capital Medical University, Beijing Institute for Brain Disorders, Beijing, China
- National Clinical Research Center for Geriatric Disorders, Beijing, China
- Pacific Parkinson’s Research Centre, University of British Columbia, Vancouver, Canada
| | - Saurabh Garg
- Pacific Parkinson’s Research Centre, University of British Columbia, Vancouver, Canada
| | - Fang Ba
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Ai-Ping Liu
- Department of Electronic Science and Technology, University of Science and Technology of China, Hefei, China
| | - Pei-Peng Liang
- Beijing Key Laboratory of Learning and Cognition, School of Psychology, Capital Normal University, Beijing, China
| | - Lin-Lin Gao
- Department of Neurology, Neurobiology and Geriatrics, Xuanwu Hospital of Capital Medical University, Beijing Institute for Brain Disorders, Beijing, China
| | - Qian Jia
- Department of Neurology, Neurobiology and Geriatrics, Xuanwu Hospital of Capital Medical University, Beijing Institute for Brain Disorders, Beijing, China
| | - Er-He Xu
- Department of Neurology, Neurobiology and Geriatrics, Xuanwu Hospital of Capital Medical University, Beijing Institute for Brain Disorders, Beijing, China
| | - Kun-Cheng Li
- Department of Radiology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Piu Chan
- Department of Neurology, Neurobiology and Geriatrics, Xuanwu Hospital of Capital Medical University, Beijing Institute for Brain Disorders, Beijing, China
- National Clinical Research Center for Geriatric Disorders, Beijing, China
- Clinical Center for Parkinson’s Disease, Capital Medical University, Beijing, China
- Key Laboratory for Neurodegenerative Disease of the Ministry of Education, Beijing Key Laboratory for Parkinson’s Disease, Beijing, China
| | - Martin J. McKeown
- Pacific Parkinson’s Research Centre, University of British Columbia, Vancouver, Canada
- Department of Electronic Science and Technology, University of Science and Technology of China, Hefei, China
- Department of Medicine (Neurology), University of British Columbia, Vancouver, Canada
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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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Gao C, Liu J, Tan Y, Chen S. Freezing of gait in Parkinson's disease: pathophysiology, risk factors and treatments. Transl Neurodegener 2020; 9:12. [PMID: 32322387 PMCID: PMC7161193 DOI: 10.1186/s40035-020-00191-5] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 03/24/2020] [Indexed: 12/14/2022] Open
Abstract
Background Freezing of gait (FOG) is a common, disabling symptom of Parkinson's disease (PD), but the mechanisms and treatments of FOG remain great challenges for clinicians and researchers. The main focus of this review is to summarize the possible mechanisms underlying FOG, the risk factors for screening and predicting the onset of FOG, and the clinical trials involving various therapeutic strategies. In addition, the limitations and recommendations for future research design are also discussed. Main body In the mechanism section, we briefly introduced the physiological process of gait control and hypotheses about the mechanism of FOG. In the risk factor section, gait disorders, PIGD phenotype, lower striatal DAT uptake were found to be independent risk factors of FOG with consistent evidence. In the treatment section, we summarized the clinical trials of pharmacological and non-pharmacological treatments. Despite the limited effectiveness of current medications for FOG, especially levodopa resistant FOG, there were some drugs that showed promise such as istradefylline and rasagiline. Non-pharmacological treatments encompass invasive brain and spinal cord stimulation, noninvasive repetitive transcranial magnetic stimulation (rTMS) or transcranial direct current stimulation (tDCS) and vagus nerve stimulation (VNS), and physiotherapeutic approaches including cues and other training strategies. Several novel therapeutic strategies seem to be effective, such as rTMS over supplementary motor area (SMA), dual-site DBS, spinal cord stimulation (SCS) and VNS. Of physiotherapy, wearable cueing devices seem to be generally effective and promising. Conclusion FOG model hypotheses are helpful for better understanding and characterizing FOG and they provide clues for further research exploration. Several risk factors of FOG have been identified, but need combinatorial optimization for predicting FOG more precisely. Although firm conclusions cannot be drawn on therapeutic efficacy, the literature suggested that some therapeutic strategies showed promise.
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Affiliation(s)
- Chao Gao
- 1Department of Neurology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Liu
- 1Department of Neurology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuyan Tan
- 1Department of Neurology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shengdi Chen
- 1Department of Neurology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.,2Co-innovation Center of Neuroregeneration, Nantong University, Nantong, Jiangsu Province China
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