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Qiu T, Liu M, Qiu X, Li T, Le W. Cerebellar involvement in Parkinson's disease: Pathophysiology and neuroimaging. Chin Med J (Engl) 2024:00029330-990000000-01208. [PMID: 39227357 DOI: 10.1097/cm9.0000000000003248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Indexed: 09/05/2024] Open
Abstract
ABSTRACT Parkinson's disease (PD) is a neurodegenerative disease characterized by various motor and non-motor symptoms. The complexity of its symptoms suggests that PD is a heterogeneous neurological disorder. Its pathological changes are not limited to the substantia nigra-striatal system, but gradually extending to other regions including the cerebellum. The cerebellum is connected to a wide range of central nervous system regions that form essential neural circuits affected by PD. In addition, altered dopaminergic activity and α-synuclein pathology are found in the cerebellum, further suggesting its role in the PD progression. Furthermore, an increasing evidence obtained from imaging studies has demonstrated that cerebellar structure, functional connectivity, and neural metabolism are altered in PD when compared to healthy controls, as well as among different PD subtypes. This review provides a comprehensive summary of the cerebellar pathophysiology and results from neuroimaging studies related to both motor and non-motor symptoms of PD, highlighting the potential significance of cerebellar assessment in PD diagnosis, differential diagnosis, and disease monitoring.
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Affiliation(s)
- Tao Qiu
- Key Laboratory of Liaoning Province for Research on the Pathogenic Mechanisms of Neurological Diseases, the First Affiliated Hospital, Dalian Medical University, Dalian, Liaoning 116000, China
| | - Meichen Liu
- Key Laboratory of Liaoning Province for Research on the Pathogenic Mechanisms of Neurological Diseases, the First Affiliated Hospital, Dalian Medical University, Dalian, Liaoning 116000, China
| | - Xinhui Qiu
- Key Laboratory of Liaoning Province for Research on the Pathogenic Mechanisms of Neurological Diseases, the First Affiliated Hospital, Dalian Medical University, Dalian, Liaoning 116000, China
| | - Tianbai Li
- Key Laboratory of Liaoning Province for Research on the Pathogenic Mechanisms of Neurological Diseases, the First Affiliated Hospital, Dalian Medical University, Dalian, Liaoning 116000, China
| | - Weidong Le
- Key Laboratory of Liaoning Province for Research on the Pathogenic Mechanisms of Neurological Diseases, the First Affiliated Hospital, Dalian Medical University, Dalian, Liaoning 116000, China
- Center for Clinical and Translational Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai 200000, 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 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] [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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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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Lench DH, Doolittle JD, Ramakrishnan V, Rowland N, Revuelta GJ. Subthalamic functional connectivity associated with freezing of gait dopa-response. Parkinsonism Relat Disord 2024; 118:105952. [PMID: 38101024 PMCID: PMC10872230 DOI: 10.1016/j.parkreldis.2023.105952] [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: 07/24/2023] [Revised: 12/01/2023] [Accepted: 12/04/2023] [Indexed: 12/17/2023]
Abstract
INTRODUCTION Freezing of gait (FOG) is a prevalent and debilitating feature of Parkinson's Disease (PD). The subthalamic nucleus (STN) is a center for controlled locomotion and a common DBS target. The objective of this study was to identify STN circuitry associated with FOG response to dopaminergic medication. In this study, we compare BOLD functional connectivity of the subthalamic nucleus (STN) in participants with and without dopa-responsive FOG. METHODS 55 PD participants either with FOG (n = 38) or without FOG (n = 17) were recruited. Among FOG participants 22 were dopa-responsive and 16 were dopa-unresponsive. STN whole-brain connectivity was performed using CONN toolbox. The relationship between the degree of self-reported FOG dopa-response and STN connectivity was evaluated using partial correlations corrected for age, disease duration, and levodopa equivalent daily dose. RESULTS Right STN connectivity with the cerebellar locomotor region and the temporal/occipital cortex was greater in the dopa-responsive FOG group (voxel threshold p < 0.01, FWE corrected p < 0.05). Left STN connectivity with the occipital cortex was greater in the dopa-responsive FOG group and connectivity with the postcentral gyrus was greater in the dopa-unresponsive FOG group. Strength of connectivity to these regions correlated with l-dopa induced improvement in UPDRS Item-14 (FOG), but not UPDRS Part-III (overall motor score). DISCUSSION We demonstrate that dopa-unresponsive FOG is associated with changes in BOLD functional connectivity between the STN and locomotor as well as sensory processing regions. This finding supports the conceptual framework that effective treatment for freezing of gait likely requires the engagement of both locomotor and sensory brain regions.
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Affiliation(s)
- Daniel H. Lench
- Department of Neurology, Medical University of South Carlina, Charleston, SC, USA
| | - Jade D. Doolittle
- Department of Neurology, Medical University of South Carlina, Charleston, SC, USA
| | | | - Nathan Rowland
- Department of Neurosurgery, Medical University of South Carlina, Charleston, SC, USA
- MUSC Institute for Neuroscience Discovery (MIND), Medical University of South Carolina, Charleston, SC 29425, USA
| | - Gonzalo J. Revuelta
- Department of Neurology, Medical University of South Carlina, Charleston, SC, USA
- Ralph H. Johnson VA Medical Center, Charleston, SC, USA
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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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Li R, Wang Y, Li H, Liu J, Liu S. Two similar carbon monoxide poisoning cases with different outcomes: evidence from longitudinal fMRI. Neurocase 2023; 29:58-65. [PMID: 38406979 DOI: 10.1080/13554794.2024.2315858] [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: 08/29/2022] [Accepted: 01/18/2024] [Indexed: 02/27/2024]
Abstract
Prognosis after carbon monoxide (CO) poisoning is difficult to assess using structural images. Functional connectivity provided by functional magnetic resonance imaging (fMRI) may explain the mechanism of differential prognosis. We report here two cases of carbon monoxide poisoning with simultaneous coma. They were nearly normal on days 7-8, but diagnosed with delayed neurological sequelae (DNS) with cognitive and motor impairments on days 22-29. Similar Methylprednisolone pulse therapy and hyperbaric oxygen therapy were given to them. The movement disorder of case 1 improved slightly during the recovery stage, while the movement disorder of case 2 worsened significantly. In case 1, the function of supplementary motor area decreased first and then increased, and the function of pallidum increased first and then decreased. Case 2 showed a reduction in the supplementary motor area and small changes in the pallidum after DNS, but both were reduced during recovery stage. The cognitive ability of case 1 remained poor, while that of case 2 improved during the recovery stage. FMRI showed damage to the right and bilateral hippocampus in case 1 and partial damage to the left hippocampus in case 2. Taken together, fMRI can be a useful method to study functional connectivity abnormalities corresponding to different prognoses.
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Affiliation(s)
- Ran Li
- Department of Rehabilitation Center, Fuxing Hospital, Capital Medical University, Beijing, China
| | - Yong Wang
- Department of Rehabilitation Center, Fuxing Hospital, Capital Medical University, Beijing, China
| | - Haidong Li
- Department of Rehabilitation Center, Fuxing Hospital, Capital Medical University, Beijing, China
| | - Jie Liu
- Department of Rehabilitation Center, Fuxing Hospital, Capital Medical University, Beijing, China
| | - Sujuan Liu
- Department of Rehabilitation Center, Fuxing Hospital, Capital Medical University, Beijing, China
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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 L, Gan C, Sun H, Ji M, Zhang H, Cao X, Wang M, Yuan Y, Zhang K. Impaired structural and reserved functional topological organizations of brain networks in Parkinson's disease with freezing of gait. Quant Imaging Med Surg 2023; 13:66-79. [PMID: 36620158 PMCID: PMC9816763 DOI: 10.21037/qims-22-351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 09/16/2022] [Indexed: 01/11/2023]
Abstract
Background Freezing of gait (FOG) is a common disabling motor disturbance in Parkinson's disease (PD). Our study aimed to probe the topological organizations of structural and functional brain networks and their coupling in FOG. Methods In this cross-sectional retrospective study, a total of 30 PD patients with FOG (PD-FOG), 40 patients without FOG, and 25 healthy controls (HCs) underwent clinical assessments and magnetic resonance imaging (MRI) scanning. Large-scale structural and functional brain networks were constructed. Subsequently, global and nodal graph theoretical properties and functional-structural coupling were investigated. Finally, correlations between the altered brain topological properties and freezing severity were analyzed in PD-FOG. Results For structural networks, at the global level, PD-FOG exhibited increased normalized characteristic path length (P=0.040, Bonferroni-corrected) and decreased global efficiency (P=0.005, Bonferroni-corrected) compared with controls, and showed reduced global (P=0.001, Bonferroni-corrected) and local (P=0.032, Bonferroni-corrected) efficiency relative to patients without FOG. At the nodal level, nodal efficiency of structural networks was reduced in PD-FOG compared with PD patients without FOG, located in the left supplementary motor area (SMA), gyrus rectus, and middle cingulate cortex (MCC) (all P<0.05, Bonferroni-corrected). Notably, altered global and nodal properties of structural networks were significantly correlated with Freezing of Gait Questionnaire scores [all P<0.05, false discovery rate (FDR)-corrected]. However, only an increase in local efficiency (P=0.003, Bonferroni-corrected) of functional networks was identified in PD-FOG compared with those without FOG. No significant structural-functional coupling was detected among the 3 groups. Conclusions This study demonstrates the extensively impaired structural and relatively reserved functional network topological organizations in PD-FOG. Our results also provide evidence that the pathogenesis of PD-FOG is primarily attributable to network vulnerability established by crucial structural damage, especially in the left SMA, gyrus rectus, and MCC.
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Affiliation(s)
- Lina Wang
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Caiting Gan
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Huimin Sun
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Min Ji
- 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
| | - Xingyue Cao
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Min Wang
- Department of Radiology, 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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Potvin-Desrochers A, Atri A, Moreno AM, Paquette C. Levodopa alters resting-state functional connectivity more selectively in Parkinson's disease with freezing of gait. Eur J Neurosci 2023; 57:163-177. [PMID: 36251568 DOI: 10.1111/ejn.15849] [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: 06/08/2022] [Revised: 09/23/2022] [Accepted: 10/11/2022] [Indexed: 02/02/2023]
Abstract
Freezing of gait (FOG) is a debilitating motor symptom of Parkinson's disease (PD). Although PD dopaminergic medication (L-DOPA) seems to generally reduce FOG severity, its effect on neural mechanisms of FOG remains to be determined. The purpose of this study was to quantify the effect of L-DOPA on brain resting-state functional connectivity in individuals with FOG. Functional magnetic resonance imaging was acquired at rest in 30 individuals living with PD (15 freezers) in the ON- and OFF- medication state. A seed-to-voxel analysis was performed with seeds in the bilateral basal ganglia nuclei, the thalamus and the mesencephalic locomotor region. In freezers, medication-state contrasts revealed numerous changes in resting-state functional connectivity, not modulated by L-DOPA in non-freezers. In freezers, L-DOPA increased the functional connectivity between the seeds and regions including the posterior parietal, the posterior cingulate, the motor and the medial prefrontal cortices. Comparisons with non-freezers revealed that L-DOPA generally normalizes brain functional connectivity to non-freezers levels but can also increase functional connectivity, possibly compensating for dysfunctional networks in freezers. Our findings suggest that L-DOPA could contribute to a better sensorimotor, attentional, response inhibition and limbic processing to prevent FOG when triggers are encountered but could also contribute to FOG by interfering with the processing capacity of the striatum. This study shows that levodopa taken to control PD symptoms induces changes in functional connectivity at rest, in freezers only. Increases (green) in functional connectivity of GPe, GPi, putamen and thalamus with cognitive, sensorimotor and limbic cortical regions of the Interference model (blue) was observed. Our results suggest that levodopa can normalize connections similar to non-freezers or increases connectivity to compensate for dysfunctional networks.
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Affiliation(s)
- Alexandra Potvin-Desrochers
- Department of Kinesiology and Physical Education Montréal, McGill University, Montreal, Québec, Canada.,Integrated Program in Neuroscience, McGill University, Montreal, Québec, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Jewish Rehabilitation Hospital-CISSS de Laval, Laval, Québec, Canada
| | - Alisha Atri
- Department of Kinesiology and Physical Education Montréal, McGill University, Montreal, Québec, Canada
| | - Alejandra Martinez Moreno
- Department of Kinesiology and Physical Education Montréal, McGill University, Montreal, Québec, Canada.,Integrated Program in Neuroscience, McGill University, Montreal, Québec, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Jewish Rehabilitation Hospital-CISSS de Laval, Laval, Québec, Canada
| | - Caroline Paquette
- Department of Kinesiology and Physical Education Montréal, McGill University, Montreal, Québec, Canada.,Integrated Program in Neuroscience, McGill University, Montreal, Québec, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Jewish Rehabilitation Hospital-CISSS de Laval, Laval, Québec, Canada
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Xia Y, Tang X, Hu R, Liu J, Zhang Q, Tian S, Wang W, Li C, Zhu Y. Cerebellum-Cerebrum paired target magnetic stimulation on balance function and brain network of patients with stroke: A functional near-infrared spectroscopy pilot study. Front Neurol 2022; 13:1071328. [PMID: 36619935 PMCID: PMC9813387 DOI: 10.3389/fneur.2022.1071328] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 11/24/2022] [Indexed: 12/24/2022] Open
Abstract
Transcranial magnetic stimulation (TMS) modulation over the cerebellum, primary motor cortex, and supplementary motor cortex individually can improve the balance function of patients with stroke. However, whether their combination could have a better balance modulation effect is uncertain. Therefore, we hypothesized that performing TMS over a combination of these targets can regulate the balance function of patients with stroke. We compared the effects of one-session TMS on eye-open and eye-closed balance conditions in patients with stroke, using different target pairs of unilateral cerebellar (CB-single), cerebellar-primary motor cortex (CB-M1), and cerebellar-supplementary motor area (CB-SMA) targets. A total of 31 patients with stroke were enrolled and randomly divided into three groups to receive single sessions of intermittent theta burst stimulation each. Functional near-infrared spectrum data on resting and standing task states (eye-open and eye-closed) and center of pressure parameters (eye-open and eye-closed) were collected before and after the intervention. Compared with the results in the CB-single group, five intergroup differences in the changes in the center of pressure parameters in the CB-M1 group and two significant differences in the CB-SMA group were observed after one session of intermittent theta burst stimulation. In the CB-SMA group, 12 out of the 14 parameters improved significantly in the EC condition after the intervention. Meanwhile, the functional near-infrared spectrum results showed that the CB-SMA group exhibited a significant inhibitory pattern in the resting-state functional connectivity, which was not observed in the other two groups. In conclusion, we believe that paired targeting of the CB-SMA can reshape the brain network and improve the balance function of patients with stroke.
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Li R, He Y, Qin W, Zhang Z, Su J, Guan Q, Chen Y, Jin L. Effects of Repetitive Transcranial Magnetic Stimulation on Motor Symptoms in Parkinson's Disease: A Meta-Analysis. Neurorehabil Neural Repair 2022; 36:395-404. [PMID: 35616427 DOI: 10.1177/15459683221095034] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Transcranial magnetic stimulation (TMS) is a non-invasive neuromodulation technique that has been closely examined as a possible treatment for Parkinson's disease (PD). Owing to various rTMS protocols and results, the optimal mode and suitable PD symptoms have yet to be established. OBJECTIVES This study intends to systematically evaluate the efficacy of rTMS intervention and identify optimal stimulation protocol of rTMS for specific motor symptoms. METHODS PubMed and web of Science databases were searched before January 2022. Eligible studies included sham-controlled and randomized clinical trials of rTMS intervention for motor dysfunction in patients with PD. Standard mean difference (SMD) was calculated with random-effects models. The effects of rTMS on motor symptoms were mainly estimated by the UPDRS-III. RESULTS A total of 1172 articles were identified, of which 32 articles met the inclusion criteria for meta-analysis. The pooled evidence suggested that rTMS relieves motor symptoms of patients with PD (SMD 0.64, 95%CI [0.47, 0.80]). High frequency stimulation on M1 is the most effective mode of intervention (SMD 0.79, 95%CI [0.52, 1.07]). HF rTMS has significant therapeutic effects on limbs motor function (SMD 1.93, 95%CI [0.73, 3.12] for upper limb function and SMD 0.88, 95%CI [0.43, 1.33] for lower limb function), akinesia (SMD 1.17, 95%CI [0.43, 1.92), rigidity (SMD 1.02, 95%CI [0.12, 1.92]) and tremor(SMD 0.91, 95%CI [0.15, 1.67]). CONCLUSION rTMS therapy is an effective treatment for motor symptoms of PD and the individualized stimulation protocols for different symptoms would further improve its clinical efficacy.
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Affiliation(s)
- Ruoyu Li
- Neurotoxin research center of Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of Education, Neurological Department of Tongji Hospital, School of Medicine, Tongji University, Shanghai, P. R. China
| | - Yijing He
- Neurotoxin research center of Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of Education, Neurological Department of Tongji Hospital, School of Medicine, Tongji University, Shanghai, P. R. China
| | - Wenting Qin
- Neurotoxin research center of Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of Education, Neurological Department of Tongji Hospital, School of Medicine, Tongji University, Shanghai, P. R. China
| | - Zhuoyu Zhang
- Neurotoxin research center of Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of Education, Neurological Department of Tongji Hospital, School of Medicine, Tongji University, Shanghai, P. R. China
| | - Junhui Su
- Neurotoxin research center of Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of Education, Neurological Department of Tongji Hospital, School of Medicine, Tongji University, Shanghai, P. R. China
| | - Qiang Guan
- Neurotoxin research center of Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of Education, Neurological Department of Tongji Hospital, School of Medicine, Tongji University, Shanghai, P. R. China
| | - Yuhui Chen
- Neurotoxin research center of Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of Education, Neurological Department of Tongji Hospital, School of Medicine, Tongji University, Shanghai, P. R. China
| | - Lingjing Jin
- Neurotoxin research center of Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of Education, Neurological Department of Tongji Hospital, School of Medicine, Tongji University, Shanghai, P. R. China.,Department of Neurology and Neurological Rehabilitation, Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
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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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