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Fortier-Lebel N, Nakajima T. Exploring the Consistent Roles of Motor Areas Across Voluntary Movement and Locomotion. Neuroscientist 2024:10738584241263758. [PMID: 39041460 DOI: 10.1177/10738584241263758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
Multiple cortical motor areas are critically involved in the voluntary control of discrete movement (e.g., reaching) and gait. Here, we outline experimental findings in nonhuman primates with clinical reports and research in humans that explain characteristic movement control mechanisms in the primary, supplementary, and presupplementary motor areas, as well as in the dorsal premotor area. We then focus on single-neuron activity recorded while monkeys performed motor sequences consisting of multiple discrete movements, and we consider how area-specific control mechanisms may contribute to the performance of complex movements. Following this, we explore the motor areas in cats that we have considered as analogs of those in primates based on similarities in their cortical surface topology, anatomic connections, microstimulation effects, and activity patterns. Emphasizing that discrete movement and gait modification entail similar control mechanisms, we argue that single-neuron activity in each area of the cat during gait modification is compatible with the function ascribed to the activity in the corresponding area in primates, recorded during the performance of discrete movements. The findings that demonstrate the premotor areas' contribution to locomotion, currently unique to the cat model, should offer highly valuable insights into the control mechanisms of locomotion in primates, including humans.
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Affiliation(s)
- Nicolas Fortier-Lebel
- Département de neurosciences, Département de médecine, Centre interdisciplinaire de recherche sur le cerveau et l'apprentissage, Groupe de recherche sur la signalisation neurale et la circuiterie, Université de Montréal, Montréal, Canada
| | - Toshi Nakajima
- Department of Physiology, Faculty of Medicine, Kindai University, Osaka-Sayama, Japan
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2
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Richer N, Bradford JC, Ferris DP. Mobile neuroimaging: What we have learned about the neural control of human walking, with an emphasis on EEG-based research. Neurosci Biobehav Rev 2024; 162:105718. [PMID: 38744350 DOI: 10.1016/j.neubiorev.2024.105718] [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: 10/30/2023] [Revised: 04/18/2024] [Accepted: 05/08/2024] [Indexed: 05/16/2024]
Abstract
Our understanding of the neural control of human walking has changed significantly over the last twenty years and mobile brain imaging methods have contributed substantially to current knowledge. High-density electroencephalography (EEG) has the advantages of being lightweight and mobile while providing temporal resolution of brain changes within a gait cycle. Advances in EEG hardware and processing methods have led to a proliferation of research on the neural control of locomotion in neurologically intact adults. We provide a narrative review of the advantages and disadvantages of different mobile brain imaging methods, then summarize findings from mobile EEG studies quantifying electrocortical activity during human walking. Contrary to historical views on the neural control of locomotion, recent studies highlight the widespread involvement of many areas, such as the anterior cingulate, posterior parietal, prefrontal, premotor, sensorimotor, supplementary motor, and occipital cortices, that show active fluctuations in electrical power during walking. The electrocortical activity changes with speed, stability, perturbations, and gait adaptation. We end with a discussion on the next steps in mobile EEG research.
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Affiliation(s)
- Natalie Richer
- Department of Kinesiology and Applied Health, University of Winnipeg, Winnipeg, Manitoba, Canada.
| | - J Cortney Bradford
- US Army Combat Capabilities Development Command US Army Research Laboratory, Adelphi, MD, USA
| | - Daniel P Ferris
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA
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3
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Mermelstein S, Barbosa P, Kaski D. Neurological gait assessment. Pract Neurol 2024; 24:11-21. [PMID: 38135498 DOI: 10.1136/pn-2023-003917] [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] [Accepted: 11/04/2023] [Indexed: 12/24/2023]
Abstract
Gait disorders are a common feature of neurological disease. The gait examination is an essential part of the neurological clinical assessment, providing valuable clues to a myriad of causes. Understanding how to examine gait is not only essential for neurological diagnosis but also for treatment and prognosis. Here, we review aspects of the clinical history and examination of neurological gait to help guide gait disorder assessment. We focus particularly on how to differentiate between common gait abnormalities and highlight the characteristic features of the more prevalent neurological gait patterns such as ataxia, waddling, steppage, spastic gait, Parkinson's disease and functional gait disorders. We also offer diagnostic clues for some unusual gait presentations, such as dystonic, stiff-person and choreiform gait, along with red flags that help differentiate atypical parkinsonism from Parkinson's disease.
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Affiliation(s)
- Sofia Mermelstein
- Neurology, Pedro Ernesto University Hospital, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Pedro Barbosa
- Divisão de Neurologia, Grupo de Distúrbios do Movimento, Universidade de São Paulo Hospital das Clínicas, Sao Paulo, São Paulo, Brazil
| | - Diego Kaski
- Clinical and Movement Neurosciences, UCL, London, UK
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4
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Frank Y, Levy T, Lozano R, Friedman K, Underwood S, Kostic A, Walker H, Kolevzon A. Gait Abnormalities in Children with Phelan-McDermid Syndrome. J Child Neurol 2023; 38:665-671. [PMID: 37849292 DOI: 10.1177/08830738231204395] [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] [Indexed: 10/19/2023]
Abstract
Background: Phelan-McDermid syndrome is a genetic disorder caused by haploinsufficiency of the SHANK3 gene on chromosome 22q13.3 and is characterized by autism spectrum disorder, intellectual disability, speech and language abnormalities, hypotonia, and mild dysmorphic features. Early literature in Phelan-McDermid syndrome did not include gait abnormalities as part of the syndrome although recent prospective studies report that the prevalence of gait abnormalities ranges from 55% to 94%. We compared gait abnormalities in individuals with Phelan-McDermid syndrome, idiopathic autism spectrum disorder, and typically developing controls, and explored associations between gait abnormalities, autism spectrum disorder, and intellectual functioning. Method: The study cohort consists of 67 participants between the ages of 3 and 18 years, divided into 3 groups: Phelan-McDermid syndrome (n = 46), idiopathic autism spectrum disorder (n = 11), and typically developing controls (n = 10). Gait was recorded using a video camera and scored across 26 gait features using a "Gait Clinical Observations scale" designed specifically for this study. Results: Gait abnormalities were significantly higher in the Phelan-McDermid syndrome group as compared to idiopathic autism spectrum disorder or typically developing controls. The number of gait abnormalities across groups was also significantly correlated with Intellectual Quotient/Developmental Quotient (IQ/DQ). In analysis of covariance including IQ/DQ, the effect of group was not significant, but the effect of IQ/DQ was significant. Conclusions: Overall differences in gait abnormalities were determined by the degree of intellectual disability, which was significantly higher in Phelan-McDermid syndrome.
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Affiliation(s)
- Yitzchak Frank
- Department of Psychiatry, Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Tess Levy
- Department of Psychiatry, Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Reymundo Lozano
- Department of Psychiatry, Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kate Friedman
- Department of Psychiatry, Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Slayton Underwood
- Department of Psychiatry, Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ana Kostic
- Department of Psychiatry, Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Hannah Walker
- Health and Behavior Sciences at Teachers College, Columbia University, New York, NY, USA
| | - Alexander Kolevzon
- Department of Psychiatry, Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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5
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Wang W, Guan X, Wang S, Shi L, Zhu Y, Hua P, Guo Q, Wang J. Epirubicin and gait apraxia: a real-world data analysis of the FDA Adverse Event Reporting System database. Front Pharmacol 2023; 14:1249845. [PMID: 37781696 PMCID: PMC10536159 DOI: 10.3389/fphar.2023.1249845] [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: 06/30/2023] [Accepted: 08/24/2023] [Indexed: 10/03/2023] Open
Abstract
Introduction: Epirubicin is widely used in many malignancies with good efficacy and tolerability. However, investigations about adverse events (AEs) using real-world information are still insufficient. Methods: We extracted Epirubicin-related reports submitted between the first quarter of 2014 and first quarter of 2023 from FAERS database. Four algorithms were utilized to evaluate whether there was a significant correlation between Epirubicin and AEs. Results: After de-duplicating, a total of 3919 cases were extracted. Among the 3919 cases, we identified 1472 AEs, 253 of which were found to be adverse drug reactions (ADRs) associated with Epirubicin. We analysed the occurrence of Epirubicin-induced ADRs and found several unexpected significant ADRs, such as hepatic artery stenosis, hepatic artery occlusion, intestinal atresia and so on. Interestingly, we found gait apraxia, a neurological condition, was also significantly associated with Epirubicin. To our knowledge, there haven't studies that have reported an association between gait disorders and the usage of epirubicin. Discussion: Our study identified new unexpected significant ADRs related to Epirubicin, providing new perspectives to the clinical use of Epirubicin.
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Affiliation(s)
- Wei Wang
- Department of Urology, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Xin Guan
- Department of Cardiology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Shuang Wang
- Department of Gastroenterology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Lipeng Shi
- Department of General Surgery, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Yanfei Zhu
- Department of General Surgery, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Pengbo Hua
- Department of Urology, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Qiang Guo
- Department of Urology, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Jingqi Wang
- Department of Urology, Second Hospital of Shanxi Medical University, Taiyuan, China
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Sullivan EV, Zahr NM, Sassoon SA, Pohl KM, Pfefferbaum A. Postural instability in HIV infection: relation to central and peripheral nervous system markers. AIDS 2023; 37:1085-1096. [PMID: 36927610 PMCID: PMC10164071 DOI: 10.1097/qad.0000000000003531] [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] [Indexed: 03/17/2023]
Abstract
OBJECTIVES Determine the independent contributions of central nervous system (CNS) and peripheral nervous system (PNS) metrics to balance instability in people with HIV (PWH) compared with people without HIV (PWoH). METHODS Volumetric MRI (CNS) and two-point pedal discrimination (PNS) were tested as substrates of stance instability measured with balance platform posturography. DESIGN 125 PWH and 88 PWoH underwent balance testing and brain MRI. RESULTS The PWH exhibited stability deficits that were disproportionately greater with eyes closed than eyes open compared with PWoH. Further analyses revealed that greater postural imbalance measured as longer sway paths correlated with smaller cortical and cerebellar lobular brain volumes known to serve sensory integration; identified brain/sway path relations endured after accounting for contributions from physiological and disease factors as potential moderators; and multiple regression identified PNS and CNS metrics as independent predictors of postural instability in PWH that differed with the use of visual information to stabilize balance. With eyes closed, temporal volumes and two-point pedal discrimination were significant independent predictors of sway; with eyes open, occipital volume was an additional predictor of sway. These relations were selective to PWH and were not detected in PWoH. CONCLUSION CNS and PNS factors were independent contributors to postural instability in PWH. Recognizing that myriad inputs must be detected by peripheral systems and brain networks to integrate sensory and musculoskeletal information for maintenance of postural stability, age- or disease-related degradation of either or both nervous systems may contribute to imbalance and liability for falls.
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Affiliation(s)
- Edith V. Sullivan
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | - Natalie M. Zahr
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
- Center for Health Sciences, SRI International, Menlo Park, CA
| | | | - Kilian M. Pohl
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
- Center for Health Sciences, SRI International, Menlo Park, CA
| | - Adolf Pfefferbaum
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
- Center for Health Sciences, SRI International, Menlo Park, CA
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7
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Milletti D, Randi FT, Lanzino G, Hakim F, Palandri G. Gait Apraxia and Hakim’s Disease: A Historical Review. Biomedicines 2023; 11:biomedicines11041086. [PMID: 37189704 DOI: 10.3390/biomedicines11041086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/28/2023] [Accepted: 03/31/2023] [Indexed: 04/07/2023] Open
Abstract
In 1965, Prof. Salomón Hakim described, for the first time, a condition characterized by normal pressure hydrocephalus and gait alterations. During the following decades, definitions such as “Frontal Gait”, “Bruns’ Ataxia” and “Gait Apraxia” have been frequently used in pertinent literature in the attempt to best define this peculiar motor disturbance. More recently, gait analysis has further shed light on the typical spatiotemporal gait alterations that characterize this neurological condition, but a clear and shared definition of this motor condition is still lacking. In this historical review, we described the origins of the terms “Gait Apraxia”, “Frontal Gait” and “Bruns’ Ataxia”, starting with the first works of Carl Maria Finkelburg, Fritsch and Hitzig and Steinthal during the second half of the 19th century and ending with Hakim’s studies and his formal definition of idiopathic normal pressure hydrocephalus (iNPH). In the second part of the review, we analyze how and why these definitions of gait have been associated with Hakim’s disease in the literature from 1965 to the present day. The definition of “Gait and Postural Transition Apraxia” is then proposed, but fundamental questions about the nature and mechanisms underlying this condition remain unanswered.
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Affiliation(s)
- David Milletti
- Unit of Rehabilitation Medicine, IRCCS Istituto delle Scienze Neurologiche di Bologna, 40139 Bologna, Italy
| | - Filippo Tamburini Randi
- Unit of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, 40139 Bologna, Italy
| | - Giuseppe Lanzino
- Department of Neurosurgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Fernando Hakim
- Department of Neurosurgery, Hospital Universitario Fundación Santa Fé de Bogotá, Bogotá 220246, Cundinamarca, Colombia
| | - Giorgio Palandri
- Unit of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, 40139 Bologna, Italy
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8
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Abstract
The frontal lobe is crucial and contributes to controlling truncal motion, postural responses, and maintaining equilibrium and locomotion. The rich repertoire of frontal gait disorders gives some indication of this complexity. For human walking, it is necessary to simultaneously achieve at least two tasks, such as maintaining a bipedal upright posture and locomotion. Particularly, postural control plays an extremely significant role in enabling the subject to maintain stable gait behaviors to adapt to the environment. To achieve these requirements, the frontal cortex (1) uses cognitive information from the parietal, temporal, and occipital cortices, (2) creates plans and programs of gait behaviors, and (3) acts on the brainstem and spinal cord, where the core posture-gait mechanisms exist. Moreover, the frontal cortex enables one to achieve a variety of gait patterns in response to environmental changes by switching gait patterns from automatic routine to intentionally controlled and learning the new paradigms of gait strategy via networks with the basal ganglia, cerebellum, and limbic structures. This chapter discusses the role of each area of the frontal cortex in behavioral control and attempts to explain how frontal lobe controls walking with special reference to postural control.
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Affiliation(s)
- Kaoru Takakusaki
- Department of Physiology, Division of Neuroscience, Asahikawa Medical University, Asahikawa, Japan.
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9
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Gait Apraxia with Exaggerated Upper Limb Movements as Presentation of AARS2 Related Leukoencephalopathy. Tremor Other Hyperkinet Mov (N Y) 2022; 12:24. [PMID: 35975211 PMCID: PMC9354553 DOI: 10.5334/tohm.705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 07/20/2022] [Indexed: 11/20/2022] Open
Abstract
A 55-year-old male presented with apraxia of gait with exaggerated upper limb movement with relative preservation of cognition and mild spasticity of limbs. His investigations reveal posterior-predominant leukodystrophy in brain magnetic resonance imaging (MRI) and compound heterozygous mutations in mitochondrial alanyl-transfer RNA synthetase 2 (AARS2) by next generation sequencing. His asymptomatic brother also has MRI changes with subtle mild pyramidal signs. AARS2 mutation is a rare cause of mitochondrial encephalopathy which may give rise to leukodystrophy with premature ovarian failure, infantile cardiomyopathy, lung hypoplasia and myopathy. Gait apraxia as primary presenting feature of this rare variant of mitochondrial encephalomyopathy is hitherto un-reported.
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10
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Wu J, Cao Y, Li M, Li B, Jia X, Cao L. Altered intrinsic brain activity in patients with CSF1R-related leukoencephalopathy. Brain Imaging Behav 2022; 16:1842-1853. [PMID: 35389179 DOI: 10.1007/s11682-022-00646-5] [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] [Accepted: 01/24/2022] [Indexed: 11/26/2022]
Abstract
CSF1R-related leukoencephalopathy is an adult-onset white matter disease with high disability and mortality, while little is known about its pathogenesis. This study introduced amplitude of low-frequency fluctuations (ALFF) and regional homogeneity (ReHo) based on resting-state functional magnetic resonance imaging(rsfMRI) to compare the spontaneous brain activities of patients and healthy controls, aiming to enhance our understanding of the disease. RsfMRI was performed on 16 patients and 23 healthy controls, and preprocessed for calculation of ALFF and ReHo. Permutation tests with threshold free cluster enhancement (TFCE) was applied for comparison (number of permutations = 5,000). The TFCE significance threshold was set at [Formula: see text] < 0.05. In addition, 10 was set as the minimum cluster size. Compared to healthy controls, the patient group showed decreased ALFF in right paracentral lobule, and increased ALFF in bilateral insula, hippocampus, thalamus, supramarginal and precentral gyrus, right inferior, middle and superior frontal gyrus, right superior and middle occipital gyrus, as well as left parahippocampal gyrus, fusiform, middle occipital gyrus and angular gyrus. ReHo was decreased in right supplementary motor area, paracentral lobule and precentral gyrus, while increased in right superior occipital gyrus and supramarginal gyrus, left parahippocampal gyrus, hippocampus, fusiform, middle occipital gyrus and angular gyrus, as well as bilateral middle occipital gyrus and midbrain. These results revealed altered spontaneous brain activities in CSF1R-related leukoencephalopathy, especially in limbic system and motor cortex, which may shed light on underlying mechanisms.
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Affiliation(s)
- Jingying Wu
- Department of Neurology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
- Department of Neurology and Institute of Neurology, Ruijin Hospital Affiliated To Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yikang Cao
- School of Information and Electronics Technology, Jiamusi University, Jiamusi, China
| | - Mengting Li
- School of Teacher Education, Zhejiang Normal University, Jinhua, China
| | - Binyin Li
- Department of Neurology and Institute of Neurology, Ruijin Hospital Affiliated To Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xize Jia
- Centre for Cognition and Brain Disorders, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Li Cao
- Department of Neurology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
- Department of Neurology and Institute of Neurology, Ruijin Hospital Affiliated To Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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11
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Yada T, Kawasaki T. Circumscribed supplementary motor area injury with gait apraxia including freezing of gait and shuffling gait: a case report. Neurocase 2022; 28:231-234. [PMID: 35491765 DOI: 10.1080/13554794.2022.2071628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Clinical findings in cases of injury circumscribed with SMA is no consensus. We report the case of a 60-year-old male with circumscribed SMA injury who showed freezing of gait, and shuffling gait. Twenty-one days after onset, the patient showed difficulties with the left leg swing in gait initiation (freezing of gait). In steady-state gait, the stride of the left leg swing was short (shuffling gait). Thirty-four days after onset, this phenomenon was not observed during gait. Circumscribed SMA injury can cause gait apraxia, including freezing and shuffling gait, such as in extensive SMA injury in the medial frontal cortex.
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Affiliation(s)
- Takuya Yada
- Division of Physical Therapy, Department of Rehabilitation, Tokyo Metropolitan Rehabilitation Hospital, Tokyo, Japan
| | - Tsubasa Kawasaki
- Department of Physical Therapy, School of Health Sciences, Tokyo International University, Kawagoe, Japan
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12
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Brust JC, Chamorro A. Anterior Cerebral Artery Disease. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00023-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Cuomo G, Maglianella V, Ghanbari Ghooshchy S, Zoccolotti P, Martelli M, Paolucci S, Morone G, Iosa M. Motor imagery and gait control in Parkinson's disease: techniques and new perspectives in neurorehabilitation. Expert Rev Neurother 2021; 22:43-51. [PMID: 34906019 DOI: 10.1080/14737175.2022.2018301] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Motor imagery (MI), defined as the ability to mentally represent an action without actual movement, has been used to improve motor function in athletes and, more recently, in neurological disorders such as Parkinson's disease (PD). Several studies have investigated the neural correlates of motor imagery, which change also depending on the action imagined. AREAS COVERED This review focuses on locomotion, which is a crucial activity in everyday life and is often impaired by neurological conditions. After a general discussion on the neural correlates of motor imagery and locomotion, we review the evidence highlighting the abnormalities in gait control and gait imagery in PD patients. Next, new perspectives and techniques for PD patients' rehabilitation are discussed, namely Brain Computer Interfaces (BCIs), neurofeedback, and virtual reality (VR). EXPERT OPINION Despite the few studies, the literature review supports the potential beneficial effects of motor imagery interventions in PD focused on locomotion. The development of new technologies could empower the administration of training based on motor imagery locomotor tasks, and their application could lead to new rehabilitation protocols aimed at improving walking ability in patients with PD.
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Affiliation(s)
- Giovanna Cuomo
- Department of Psychology, University of Rome "Sapienza", Rome, Italy
| | | | - Sheida Ghanbari Ghooshchy
- Department of Psychology, University of Rome "Sapienza", Rome, Italy.,IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Pierluigi Zoccolotti
- Department of Psychology, University of Rome "Sapienza", Rome, Italy.,IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Marialuisa Martelli
- Department of Psychology, University of Rome "Sapienza", Rome, Italy.,IRCCS Fondazione Santa Lucia, Rome, Italy
| | | | | | - Marco Iosa
- Department of Psychology, University of Rome "Sapienza", Rome, Italy.,IRCCS Fondazione Santa Lucia, Rome, Italy
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14
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Kawano G, Yae Y, Sakata K, Yokochi T, Imagi T, Ohbu K, Matsuishi T. Truncal Instability and Titubation in Patients With Acute Encephalopathy With Reduced Subcortical Diffusion. Front Neurol 2021; 12:740655. [PMID: 34603191 PMCID: PMC8484920 DOI: 10.3389/fneur.2021.740655] [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: 07/13/2021] [Accepted: 08/19/2021] [Indexed: 11/13/2022] Open
Abstract
The present retrospective study aimed to investigate the presence of truncal instability or titubation after the first seizure and second phase in patients with acute encephalopathy with reduced subcortical diffusion (AED). Of the 15 patients with AED who were admitted to our hospital for 3 years and 2 months and had reached developmental milestones for sitting before disease onset, six experienced moderate-to-severe truncal instability while sitting after the first seizure. These patients had a significantly longer first seizure duration and significantly lower GCS scores 12-24 h after the first seizure, as well as significantly higher Tada score and Creatinine and blood glucose levels than those with mild or no truncal instability while in a seated position after the first seizure. Three 1-year-old children with bilateral frontal lobe lesions, particularly in the bilateral prefrontal lobe regions, demonstrated truncal titubation, which has not previously been reported as a clinical feature of AED. Tada score reported to be a predictor of AED prognosis and truncal instability in the sitting position after the first seizure may represent disease severity, but not the specific lesions. Conversely, truncal titubation might be suggestive of bilateral frontal lobe lesions, particularly in patients without severe instability. Further studies on the role of bilateral prefrontal lobe lesions to truncal titubation in patients with AED using more objective evaluation methods, such as stabilometry, are necessary.
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Affiliation(s)
- Go Kawano
- Department of Pediatrics, St Mary's Hospital, Kurume, Japan
| | - Yukako Yae
- Department of Pediatrics, Kurume University Hospital, Kurume, Japan
| | - Kensuke Sakata
- Department of Pediatrics, St Mary's Hospital, Kurume, Japan
| | | | - Toru Imagi
- Department of Pediatrics, St Mary's Hospital, Kurume, Japan
| | - Keizo Ohbu
- Department of Pediatrics, St Mary's Hospital, Kurume, Japan
| | - Toyojiro Matsuishi
- Department of Pediatrics, St Mary's Hospital, Kurume, Japan.,Research Center for Children and Research Center for Rett Syndrome, St Mary's Hospital, Kurume, Japan.,Cognitive and Molecular Research Institute of Brain Diseases, Kurume University, Kurume, Japan
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15
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Weersink JB, Maurits NM, de Jong BM. Amble Gait EEG Points at Complementary Cortical Networks Underlying Stereotypic Multi-Limb Co-ordination. Front Hum Neurosci 2021; 15:691482. [PMID: 34413729 PMCID: PMC8370810 DOI: 10.3389/fnhum.2021.691482] [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: 04/06/2021] [Accepted: 07/16/2021] [Indexed: 11/15/2022] Open
Abstract
Background Walking is characterized by stable antiphase relations between upper and lower limb movements. Such bilateral rhythmic movement patterns are neuronally generated at levels of the spinal cord and brain stem, that are strongly interconnected with cortical circuitries, including the Supplementary Motor Area (SMA). Objective To explore cerebral activity associated with multi-limb phase relations in human gait by manipulating mutual attunement of the upper and lower limb antiphase patterns. Methods Cortical activity and gait were assessed by ambulant EEG, accelerometers and videorecordings in 35 healthy participants walking normally and 19 healthy participants walking in amble gait, where upper limbs moved in-phase with the lower limbs. Power changes across the EEG frequency spectrum were assessed by Event Related Spectral Perturbation analysis and gait analysis was performed. Results Amble gait was associated with enhanced Event Related Desynchronization (ERD) prior to and during especially the left swing phase and reduced Event Related Synchronization (ERS) at final swing phases. ERD enhancement was most pronounced over the putative right premotor, right primary motor and right parietal cortex, indicating involvement of higher-order organization and somatosensory guidance in the production of this more complex gait pattern, with an apparent right hemisphere dominance. The diminished within-step ERD/ERS pattern in amble gait, also over the SMA, suggests that this gait pattern is more stride driven instead of step driven. Conclusion Increased four-limb phase complexity recruits distributed networks upstream of the primary motor cortex, primarily lateralized in the right hemisphere. Similar parietal-premotor involvement has been described to compensate impaired SMA function in Parkinson’s disease bimanual antiphase movement, indicating a role as cortical support regions.
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Affiliation(s)
- Joyce B Weersink
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Natasha M Maurits
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Bauke M de Jong
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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16
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Zaleznik E, Park J. The neural basis of counting sequences. Neuroimage 2021; 237:118146. [PMID: 33965527 DOI: 10.1016/j.neuroimage.2021.118146] [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: 03/18/2021] [Revised: 04/20/2021] [Accepted: 05/01/2021] [Indexed: 10/21/2022] Open
Abstract
Sequence processing is critical for complex behavior, and counting sequences hold a unique place underlying human numerical development. Despite this, the neural bases of counting sequences remain unstudied. We hypothesized that counting sequences in adults would involve representations in sensory, order, magnitude, and linguistic codes that implicate regions in auditory, supplementary motor, posterior parietal, and inferior frontal areas, respectively. In an fMRI scanner, participants heard four-number sequences in a 2 × 2 × 2 design. The sequences were adjacent or not (e.g., 5, 6, 7, 8 vs. 5, 6, 7, 9), ordered or not (e.g., 5, 6, 7, 8 vs. 8, 5, 7, 6), and were spoken by a voice of consistent or variable identity. Then, neural substrates of counting sequences were identified by testing for the effect of consecutiveness (ordered nonadjacent versus ordered adjacent, e.g., 5, 6, 7, 9 > 5, 6, 7, 8) in the hypothesized brain regions. Violations to consecutiveness elicited brain activity in the right inferior frontal gyrus (IFG) and the supplementary motor area (SMA). In contrast, no such activation was observed in the auditory cortex, despite violations in voice identity recruiting strong activity in that region. Also, no activation was observed in the inferior parietal lobule, despite a robust effect of orderedness observed in that brain region. These findings indicate that listening to counting sequences do not automatically elicit sensory or magnitude codes but suggest that the precise increments in the sequence are tracked by the mechanism for processing ordered associations in the SMA and by the mechanism for binding individual lexical items into a cohesive whole in the IFG.
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Affiliation(s)
- Eli Zaleznik
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, United States
| | - Joonkoo Park
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, United States; Commonwealth Honors College, University of Massachusetts Amherst, 135 Hicks Way, Amherst MA 01003, United States.
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17
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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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18
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Lammers F, Zacharias N, Borchers F, Mörgeli R, Spies CD, Winterer G. Functional Connectivity of the Supplementary Motor Network Is Associated with Fried's Modified Frailty Score in Older Adults. J Gerontol A Biol Sci Med Sci 2021; 75:2239-2248. [PMID: 31900470 DOI: 10.1093/gerona/glz297] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Indexed: 01/22/2023] Open
Abstract
Frailty is a geriatric syndrome defined by coexistence of unintentional weight loss, low physical reserve, or activity and is associated with adverse health events. Neuroimaging studies reported structural white matter changes in frail patients. In the current study, we hypothesized that clinical frailty is associated also with functional changes in motion-related cortical areas, that is, (pre-)supplementary motor areas (SMA, pre-SMA). We expected that observed functional changes are related to motor-cognitive test performance. We studied a clinical sample of 143 cognitively healthy patients ≥65 years presenting for elective surgery, enrolled in the BioCog prospective multicentric cohort study on postoperative cognitive disorders. Participants underwent preoperative resting-state functional magnetic resonance imaging, motor-cognitive testing, and assessment of Fried's modified frailty criteria. We analyzed functional connectivity associations with frailty and motor-cognitive test performance. Clinically robust patients (N = 60) showed higher connectivity in the SMA network compared to frail (N = 13) and prefrail (N = 70) patients. No changes were found in the pre-SMA network. SMA connectivity correlated with motor speed (Trail-Making-Test A) and manual dexterity (Grooved Pegboard Test). Our results suggest that diminished functional connectivity of the SMA is an early correlate of functional decline in the older adults . The SMA may serve as a potential treatment target in frailty.
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Affiliation(s)
- Florian Lammers
- Department of Anaesthesiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Germany
| | - Norman Zacharias
- Department of Anaesthesiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Germany.,Pharmaimage Biomarker Solutions GmbH, Berlin, Germany
| | - Friedrich Borchers
- Department of Anaesthesiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Germany
| | - Rudolf Mörgeli
- Department of Anaesthesiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Germany
| | - Claudia Doris Spies
- Department of Anaesthesiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Germany
| | - Georg Winterer
- Department of Anaesthesiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Germany.,Pharmaimage Biomarker Solutions GmbH, Berlin, Germany
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19
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Brugger F, Wegener R, Walch J, Galovic M, Hägele-Link S, Bohlhalter S, Kägi G. Altered activation and connectivity of the supplementary motor cortex at motor initiation in Parkinson’s disease patients with freezing. Clin Neurophysiol 2020; 131:2171-2180. [DOI: 10.1016/j.clinph.2020.05.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 04/08/2020] [Accepted: 05/04/2020] [Indexed: 10/24/2022]
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20
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Grønbæk J, Molinari E, Avula S, Wibroe M, Oettingen G, Juhler M. The supplementary motor area syndrome and the cerebellar mutism syndrome: a pathoanatomical relationship? Childs Nerv Syst 2020; 36:1197-1204. [PMID: 31127340 DOI: 10.1007/s00381-019-04202-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 05/09/2019] [Indexed: 01/25/2023]
Abstract
PURPOSE The supplementary motor area (SMA) syndrome affects adults after tumour resection in SMA neighbouring motor cortex. Cerebellar mutism syndrome (CMS) affects children after tumour resection in the posterior fossa. Both syndromes include disturbances in speech and motor function. The causes of the syndromes are unknown; however, surgical damage to the dentato-thalamo-cortical pathway (DTCP) has been associated with CMS. Thus, an anatomical link between the areas associated with the syndromes is possible. We discuss the syndromes and their possible relationship through the DTCP. METHODS We identified 61 articles (cohort studies, case reports and reviews) in MEDLINE and Embase searching for CMS, SMA syndrome or DTCP or synonyms and reviewed for evidence linking CMS and SMA. RESULTS We found that SMA syndrome and CMS are similar regarding (1) surgical causation; (2) symptoms including speech impairment, disturbance in motor function and facial dysfunction; (3) delayed onset; (4) the courses of the syndromes are transient; and (5) long-term sequelae are seen in both. Relevant differences include age predominance of adults in SMA syndrome versus children in CMS. CONCLUSIONS The similarities of the two syndromes could be traced back to their mutual connection through the DTCP and their membership to a cerebro-cerebellar circuit. The connectivity network could explain the emotional changes and speech reduction in CMS. The difference in time of post-surgical onset may be related to the anatomical distance between the surgical damage to the cerebellum and the SMA, respectively, and the effector neural loop underpinning symptoms.
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Affiliation(s)
- Jonathan Grønbæk
- Department of Neurosurgery, The University Hospital Rigshospitalet, Copenhagen, Denmark.
- Department of Paediatrics and Adolescent Medicine, The University Hospital Rigshospitalet, Copenhagen, Denmark.
| | - Emanuela Molinari
- Department of Neurology, The Queen Elizabeth University Hospital, University of Glasgow, Glasgow, UK
| | - Shivaram Avula
- Department of Radiology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Morten Wibroe
- Department of Neurosurgery, The University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Paediatrics and Adolescent Medicine, The University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Gorm Oettingen
- Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark
| | - Marianne Juhler
- Department of Neurosurgery, The University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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21
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Höllerhage M. Secondary parkinsonism due to drugs, vascular lesions, tumors, trauma, and other insults. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2019; 149:377-418. [PMID: 31779822 DOI: 10.1016/bs.irn.2019.10.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
In addition to neurodegenerative disorders, there are many secondary forms of parkinsonism. The most common cause for secondary parkinsonism is the intake of distinct drugs. Neuroleptics and calcium channel blockers have been mainly described to induce parkinsonism, but also other drugs were suspected to cause or worsen parkinsonism. Another common cause for secondary parkinsonism are vascular lesions (i.e. vascular parkinsonism). Furthermore, also brain tumors have been described as rare causes for parkinsonism. Moreover, parkinsonism can be caused by chronic traumatic encephalopathy, which is a special case, since secondary insults to the brain leads to the occurrence of a neuropathologically defined disease. Other rare causes for secondary parkinsonism are lesions caused by infectious or immunological diseases as well as toxins or street drugs.
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Affiliation(s)
- Matthias Höllerhage
- Department for Neurology Hannover Medical School (MHH), Hannover, Germany; German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
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22
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Weersink JB, Maurits NM, de Jong BM. EEG time-frequency analysis provides arguments for arm swing support in human gait control. Gait Posture 2019; 70:71-78. [PMID: 30826690 DOI: 10.1016/j.gaitpost.2019.02.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 01/31/2019] [Accepted: 02/22/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Human gait benefits from arm swing, which requires four-limb co-ordination. The Supplementary Motor Area (SMA) is involved in multi-limb coordination. With its location anterior to the leg motor cortex and the pattern of its connections, this suggests a distinct role in gait control. RESEARCH QUESTION Is the SMA functionally implicated in gait-related arm swing? METHODS Ambulant electroencephalography (EEG) was employed during walking with and without arm swing in twenty healthy subjects (mean age: 64.9yrs, SD 7.2). Power changes across the EEG frequency spectrum were assessed by Event Related Spectral Perturbation (ERSP) analysis over both the putative SMA at electrode position Fz and additional sensorimotor regions. RESULTS During walking with arm swing, midline electrodes Fz and Cz showed a step-related pattern of Event Related Desynchronization (ERD) followed by Event Related Synchronization (ERS). Walking without arm swing was associated with significant ERD-ERS power reduction in the high-beta/low-gamma band over Fz and a power increase over Cz. Electrodes C3 and C4 revealed a pattern of ERD during contralateral- and ERS during ipsilateral leg swing. This ERD power decreased in gait without arm swing (low-frequency band). The ERSP pattern during walking with arm swing was similar at CP1 and CP2: ERD was seen during double support and the initial swing phase of the right leg, while a strong ERS emerged during the second half of the left leg's swing. Walking without arm swing showed a significant power reduction of this ERD-ERS pattern over CP2, while over CP1, ERS during left leg's swing turned into ERD. CONCLUSION The relation between arm swing in walking and a step-related ERD-ERS pattern in the high-beta/low-gamma band over the putative SMA, points at an SMA contribution to integrated cyclic anti-phase movements of upper- and lower limbs. This supports a cortical underpinning of arm swing support in gait control.
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Affiliation(s)
- Joyce B Weersink
- Department of Neurology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, POB 30.001, Groningen, the Netherlands
| | - Natasha M Maurits
- Department of Neurology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, POB 30.001, Groningen, the Netherlands
| | - Bauke M de Jong
- Department of Neurology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, POB 30.001, Groningen, the Netherlands.
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23
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Asahi T, Taira T, Ikeda K, Horisawa S, Yamamoto J, Tsubono H, Sato S. Improvement of Writer's Cramp from an Old Lesion in the Contralateral Hemisphere with Transient Gait Disturbance After Thalamotomy. World Neurosurg 2019; 127:8-10. [PMID: 30928593 DOI: 10.1016/j.wneu.2019.03.199] [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: 02/11/2019] [Revised: 03/18/2019] [Accepted: 03/19/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Stereotactic ventro-oral thalamotomy has been performed in cases of focal task-specific dystonia, including writer's cramp, with excellent outcomes. However, no reports have revealed the outcome of ventro-oral thalamotomy in a patient with a contralateral cerebral lesion. We describe a patient with left-hand writer's cramp with an old lesion in the left hemisphere and transient gait disturbance after right ventro-oral thalamotomy. CASE DESCRIPTION A 43-year-old man had a hemorrhage in the left basal ganglia due to cerebral arteriovenous malformation at 22 years of age, and right hemiparesis remained as a sequela. He developed left-handed writing ability; however, he became aware of the stiffness of his left hand and difficulty in writing. Writer's cramp was diagnosed. Medical treatments were not effective, and right ventro-oral thalamotomy was performed. Although his writing ability improved, he could not walk. After performing rehabilitation, his walking completely improved, reaching the level before surgery, after 3 months, and his writer's cramp was completely cured. CONCLUSIONS In patients with basal nucleus lesions, gait disturbance may appear transiently after contralateral thalamotomy. It is crucial to fully explain the potential complications, particularly in relation to temporal gait disturbances, and obtain informed consent.
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Affiliation(s)
- Takashi Asahi
- Department of Neurosurgery, Kanazawa Neurosurgical Hospital, Kanazawa, Ishikawa, Japan.
| | - Takaomi Taira
- Department of Neurosurgery, Tokyo Women's Hospital, Tokyo, Japan
| | - Kiyonobu Ikeda
- Department of Neurosurgery, Kanazawa Neurosurgical Hospital, Kanazawa, Ishikawa, Japan
| | - Shiro Horisawa
- Department of Neurosurgery, Tokyo Women's Hospital, Tokyo, Japan
| | - Jiro Yamamoto
- Department of Neurosurgery, Kanazawa Neurosurgical Hospital, Kanazawa, Ishikawa, Japan
| | - Hiroyuki Tsubono
- Department of Medical Engineering, Kanazawa Neurosurgical Hospital, Kanazawa, Ishikawa, Japan
| | - Shuji Sato
- Department of Neurosurgery, Kanazawa Neurosurgical Hospital, Kanazawa, Ishikawa, Japan
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24
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Matsubara Y, Osaka H, Yamagata T, Ae R, Shimizu J, Oguro N. Long-term outcomes in motor and cognitive impairment with acute encephalopathy. Brain Dev 2018; 40:807-812. [PMID: 29891405 DOI: 10.1016/j.braindev.2018.05.013] [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: 09/12/2017] [Revised: 05/18/2018] [Accepted: 05/18/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Acute encephalopathy causes various sequelae, including motor disabilities and intellectual delays. Previous studies reported that cognitive impairments can also occur after acute encephalitis. Although the incidence of acute encephalopathy is high in Japan, there have been few reports on its sequelae. OBJECTIVE To characterize the neurological outcomes of pediatric patients who sought motor rehabilitation for motor dysfunction after acute encephalopathy. METHOD Subjects were 26 children who were healthy before suffering from motor dysfunction following acute encephalopathy and were referred to our pediatric rehabilitation institute during a 9-year period (August 2007-April 2017). We examined subjects' neurological status and followed sequelae for at least 8 months. RESULTS Of 26 individuals, 21 became ambulatory after several months or years during the observation period. Patients who could sit without support within 5 months after the onset of acute encephalopathy were able to walk within several months or years. Patients showing high intensity on T2-weighted sequences or "bright tree appearance" in the frontal region took an average of 7 months to develop walking, which was longer than other patients. Among ambulatory subjects, 16(76%) exhibited mild to moderate intellectual delay with a developmental quotient (DQ) under 70, and 20 (95%) exhibited cognitive impairment. There was a significant correlation between DQ scores and motor disability (p = 0.013, r = -0.481). CONCLUSIONS Although 80% of patients who had motor dysfunction caused by acute encephalopathy and visited out motor rehabilitation outpatient clinic were eventually able to walk, the time taken to develop walking ability depended on which region exhibited magnetic resonance imaging abnormalities. DQ scores and motor disability were significantly correlated.
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Affiliation(s)
- Yuri Matsubara
- Division of Public Health, Center of Community Medicine, Jichi Medical University, Japan; Department of Pediatrics, Tochigi Rehabilitation Center, Tochigi, Japan
| | - Hitoshi Osaka
- Department of Pediatrics, Jichi Medical University, Japan
| | | | - Ryusuke Ae
- Division of Public Health, Center of Community Medicine, Jichi Medical University, Japan
| | - Jun Shimizu
- Department of Pediatrics, Tochigi Rehabilitation Center, Tochigi, Japan
| | - Noriko Oguro
- Department of Pediatrics, Tochigi Rehabilitation Center, Tochigi, Japan.
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25
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Bhatt T, Patel P, Dusane S, DelDonno SR, Langenecker SA. Neural Mechanisms Involved in Mental Imagery of Slip-Perturbation While Walking: A Preliminary fMRI Study. Front Behav Neurosci 2018; 12:203. [PMID: 30319366 PMCID: PMC6168704 DOI: 10.3389/fnbeh.2018.00203] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 08/16/2018] [Indexed: 11/21/2022] Open
Abstract
Background: Behavioral evidence for cortical involvement in reactive balance control in response to environmental perturbation is established, however, the neural correlates are not known. This study aimed to examine the neural mechanisms involved in reactive balance control for recovery from slip-like perturbations using mental imagery and to evaluate the difference in activation patterns between imagined and observed slipping. Methods: Ten healthy young participants after an exposure to regular walking and slip-perturbation trial on a treadmill, performed mental imagery and observation tasks in the MR scanner. Participants received verbal instructions to imagine walking (IW), observe walking (OW), imagine slipping (IS) and observe slipping (OS) while walking. Results: Analysis using general linear model showed increased activation during IS versus IW condition in precentral gyrus, middle frontal gyrus, superior, middle and transverse temporal gyrus, parahippocampal gyrus, cingulate gyrus, insula, pulvinar nucleus of the thalamus, pons, anterior and posterior cerebellar lobes. During IS versus OS condition, there was additional activation in parahippocampus, cingulate gyrus, inferior parietal lobule, superior temporal, middle and inferior frontal gyrus. Conclusion: The findings of the current study support involvement of higher cortical and subcortical structures in reactive balance control. Greater activation during slipping could be attributed to the complexity of the sensorimotor task and increased demands to maintain postural stability during slipping as compared with regular walking. Furthermore, our findings suggest that mental imagery of slipping recruited greater neural substrates rather than observation of slipping, possibly due to increased sensory, cognitive and perceptual processing demands. New and Noteworthy: The behavioral factors contributing to falls from external perturbations while walking are better understood than neural mechanisms underlying the behavioral response. This study examines the neural activation pattern associated with reactive balance control during slip-like perturbations while walking through an fMRI paradigm. This study identified specific neural mechanisms involved in complex postural movements during sudden perturbations, to particularly determine the role of cortical structures in reactive balance control. It further highlights the specific differences in neural structures involved in regular unperturbed versus perturbed walking.
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Affiliation(s)
- Tanvi Bhatt
- Department of Physical Therapy, College of Applied Health Sciences, Chicago, IL, United States
| | - Prakruti Patel
- Department of Physical Therapy, College of Applied Health Sciences, Chicago, IL, United States
| | - Shamali Dusane
- Department of Physical Therapy, College of Applied Health Sciences, Chicago, IL, United States
| | - Sophie R. DelDonno
- Department of Psychiatry, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Scott A. Langenecker
- Department of Psychiatry, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States
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26
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Dale ML, Curtze C, Nutt JG. Apraxia of gait- or apraxia of postural transitions? Parkinsonism Relat Disord 2018; 50:19-22. [PMID: 29477458 DOI: 10.1016/j.parkreldis.2018.02.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 01/17/2018] [Accepted: 02/13/2018] [Indexed: 01/27/2023]
Abstract
"Apraxia of gait" is not a useful concept and freezing of gait should also not be considered an apraxia. The concept of apraxia may, however, be applied to distortions of postural transitions that can accompany fronto-parietal lesions.
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Affiliation(s)
- Marian L Dale
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA; Department of Neurology, Medical University of South Carolina, Charleston, SC, USA.
| | - Carolin Curtze
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA
| | - John G Nutt
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA
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27
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Yoo PE, Hagan MA, John SE, Opie NL, Ordidge RJ, O'Brien TJ, Oxley TJ, Moffat BA, Wong YT. Spatially dynamic recurrent information flow across long-range dorsal motor network encodes selective motor goals. Hum Brain Mapp 2018. [PMID: 29516636 DOI: 10.1002/hbm.24029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Performing voluntary movements involves many regions of the brain, but it is unknown how they work together to plan and execute specific movements. We recorded high-resolution ultra-high-field blood-oxygen-level-dependent signal during a cued ankle-dorsiflexion task. The spatiotemporal dynamics and the patterns of task-relevant information flow across the dorsal motor network were investigated. We show that task-relevant information appears and decays earlier in the higher order areas of the dorsal motor network then in the primary motor cortex. Furthermore, the results show that task-relevant information is encoded in general initially, and then selective goals are subsequently encoded in specifics subregions across the network. Importantly, the patterns of recurrent information flow across the network vary across different subregions depending on the goal. Recurrent information flow was observed across all higher order areas of the dorsal motor network in the subregions encoding for the current goal. In contrast, only the top-down information flow from the supplementary motor cortex to the frontoparietal regions, with weakened recurrent information flow between the frontoparietal regions and bottom-up information flow from the frontoparietal regions to the supplementary cortex were observed in the subregions encoding for the opposing goal. We conclude that selective motor goal encoding and execution rely on goal-dependent differences in subregional recurrent information flow patterns across the long-range dorsal motor network areas that exhibit graded functional specialization.
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Affiliation(s)
- Peter E Yoo
- Department of Medicine and Radiology, Melbourne Medical School, The University of Melbourne, Victoria, Australia.,Vascular Bionics Laboratory, Melbourne Brain Centre, Department of Medicine, The University of Melbourne, Victoria, Australia
| | - Maureen A Hagan
- Neuroscience Program, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
| | - Sam E John
- Department of Electrical & Electronic Engineering, The University of Melbourne, Victoria, Australia.,Vascular Bionics Laboratory, Melbourne Brain Centre, Department of Medicine, The University of Melbourne, Victoria, Australia.,The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
| | - Nicholas L Opie
- Department of Electrical & Electronic Engineering, The University of Melbourne, Victoria, Australia.,Vascular Bionics Laboratory, Melbourne Brain Centre, Department of Medicine, The University of Melbourne, Victoria, Australia.,The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
| | - Roger J Ordidge
- Department of Medicine and Radiology, Melbourne Medical School, The University of Melbourne, Victoria, Australia
| | - Terence J O'Brien
- Departments of Medicine and Neurology, Melbourne Brain Centre at The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Thomas J Oxley
- Vascular Bionics Laboratory, Melbourne Brain Centre, Department of Medicine, The University of Melbourne, Victoria, Australia.,The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia.,NeuroEngineering Laboratory, Department of Electrical &Electronic Engineering, The University of Melbourne, Melbourne, Victoria, Australia.,Departments of Medicine and Neurology, Melbourne Brain Centre at The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Bradford A Moffat
- Department of Medicine and Radiology, Melbourne Medical School, The University of Melbourne, Victoria, Australia
| | - Yan T Wong
- Department of Electrical and Computer Systems Engineering, Monash University, Victoria, Australia.,Department of Physiology, Monash University, Clayton, Victoria, Australia.,Neuroscience Program, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
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Sacheli LM, Zapparoli L, De Santis C, Preti M, Pelosi C, Ursino N, Zerbi A, Banfi G, Paulesu E. Mental steps: Differential activation of internal pacemakers in motor imagery and in mental imitation of gait. Hum Brain Mapp 2017; 38:5195-5216. [PMID: 28731517 DOI: 10.1002/hbm.23725] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 06/30/2017] [Accepted: 07/03/2017] [Indexed: 12/30/2022] Open
Abstract
Gait imagery and gait observation can boost the recovery of locomotion dysfunctions; yet, a neurologically justified rationale for their clinical application is lacking as much as a direct comparison of their neural correlates. Using functional magnetic resonance imaging, we measured the neural correlates of explicit motor imagery of gait during observation of in-motion videos shot in a park with a steady cam (Virtual Walking task). In a 2 × 2 factorial design, we assessed the modulatory effect of gait observation and of foot movement execution on the neural correlates of the Virtual Walking task: in half of the trials, the participants were asked to mentally imitate a human model shown while walking along the same route (mental imitation condition); moreover, for half of all the trials, the participants also performed rhythmic ankle dorsiflexion as a proxy for stepping movements. We found that, beyond the areas associated with the execution of lower limb movements (the paracentral lobule, the supplementary motor area, and the cerebellum), gait imagery also recruited dorsal premotor and posterior parietal areas known to contribute to the adaptation of walking patterns to environmental cues. When compared with mental imitation, motor imagery recruited a more extensive network, including a brainstem area compatible with the human mesencephalic locomotor region (MLR). Reduced activation of the MLR in mental imitation indicates that this more visually guided task poses less demand on subcortical structures crucial for internally generated gait patterns. This finding may explain why patients with subcortical degeneration benefit from rehabilitation protocols based on gait observation. Hum Brain Mapp 38:5195-5216, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Lucia Maria Sacheli
- Department of Psychology and Milan Center for Neuroscience (NeuroMI), University of Milano-Bicocca, Piazza dell'Ateneo Nuovo 1, Milan, 20126, Italy.,IRCCS Istituto Ortopedico Galeazzi, via Riccardo Galeazzi 4, Milan, 20161, Italy
| | - Laura Zapparoli
- IRCCS Istituto Ortopedico Galeazzi, via Riccardo Galeazzi 4, Milan, 20161, Italy
| | - Carlo De Santis
- Department of Psychology and Milan Center for Neuroscience (NeuroMI), University of Milano-Bicocca, Piazza dell'Ateneo Nuovo 1, Milan, 20126, Italy
| | - Matteo Preti
- Department of Psychology and Milan Center for Neuroscience (NeuroMI), University of Milano-Bicocca, Piazza dell'Ateneo Nuovo 1, Milan, 20126, Italy
| | - Catia Pelosi
- IRCCS Istituto Ortopedico Galeazzi, via Riccardo Galeazzi 4, Milan, 20161, Italy
| | - Nicola Ursino
- IRCCS Istituto Ortopedico Galeazzi, via Riccardo Galeazzi 4, Milan, 20161, Italy
| | - Alberto Zerbi
- IRCCS Istituto Ortopedico Galeazzi, via Riccardo Galeazzi 4, Milan, 20161, Italy
| | - Giuseppe Banfi
- IRCCS Istituto Ortopedico Galeazzi, via Riccardo Galeazzi 4, Milan, 20161, Italy.,University Vita e Salute San Raffaele, Milan, Italy
| | - Eraldo Paulesu
- Department of Psychology and Milan Center for Neuroscience (NeuroMI), University of Milano-Bicocca, Piazza dell'Ateneo Nuovo 1, Milan, 20126, Italy.,IRCCS Istituto Ortopedico Galeazzi, via Riccardo Galeazzi 4, Milan, 20161, Italy
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Hwang HW, Lee SH, Lyoo CH, Lee MS. Paroxysmal freezing of gait in a patient with mesial frontal transient ischemic attacks. BMC Neurol 2017; 17:122. [PMID: 28659126 PMCID: PMC5490189 DOI: 10.1186/s12883-017-0901-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 06/21/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rare patients have been reported who developed a mixture of gait disturbances following a focal lesion in the frontal lobe. Thus, the exact location of frontal lesion responsible for a specific gait disturbance is not well defined. CASE PRESENTATION We describe a 47-year-old man who experienced two episodes of paroxysmal freezing of gait of the right leg. During the attacks, he had no motor weakness, sensory change, or disequilibrium. He had past history of panic attacks. Recently, he had been under severe emotional stress. T2 and diffusion brain magnetic resonance imaging scans were normal. So far, the most likely clinical diagnosis might be functional freezing of gait. However, magnetic resonance angiography showed atherosclerosis in the proximal left anterior cerebral artery. Perfusion scans showed a delayed mean transit time in the left mesial frontal lobe. He developed two more attacks during the four months of follow up. CONCLUSIONS The presented case illustrates that the mesial frontal lobe may be important in the pathophysiology of freezing of gait. We speculate that the supplementary motor area may generate a neuronal command for the initiation of locomotion that in our case may have been inhibited by a transient ischemia.
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Affiliation(s)
- Hee Won Hwang
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Eonjuro 211, Gangnam-gu, Seoul, South Korea
| | - Seung Ha Lee
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Eonjuro 211, Gangnam-gu, Seoul, South Korea
| | - Chul Hyoung Lyoo
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Eonjuro 211, Gangnam-gu, Seoul, South Korea
| | - Myung Sik Lee
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Eonjuro 211, Gangnam-gu, Seoul, South Korea.
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Transcranial direct current stimulation (tDCS) to the supplementary motor area (SMA) influences performance on motor tasks. Exp Brain Res 2016; 235:851-859. [DOI: 10.1007/s00221-016-4848-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 11/26/2016] [Indexed: 01/07/2023]
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Birch I, Birch T, Bray D. The identification of emotions from gait. Sci Justice 2016; 56:351-356. [PMID: 27702450 DOI: 10.1016/j.scijus.2016.05.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 05/10/2016] [Accepted: 05/11/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Ivan Birch
- Sheffield Teaching Hospitals NHS Foundation Trust, Jordanthorpe Health Centre, 1 Dyche Close, Sheffield, S8 8DJ, England, United Kingdom.
| | - Tabitha Birch
- University of Kent, Canterbury, Kent, CT2 7NZ, England, United Kingdom.
| | - Diane Bray
- University of Roehampton, Department of Psychology, Erasmus House, Roehampton Lane, London SW15 5PU, United Kingdom.
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Yozu A, Obayashi S, Nakajima K, Hara Y. Hemodynamic Response of the Supplementary Motor Area during Locomotor Tasks with Upright versus Horizontal Postures in Humans. Neural Plast 2016; 2016:6168245. [PMID: 27413555 PMCID: PMC4930806 DOI: 10.1155/2016/6168245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 05/22/2016] [Indexed: 11/17/2022] Open
Abstract
To understand cortical mechanisms related to truncal posture control during human locomotion, we investigated hemodynamic responses in the supplementary motor area (SMA) with quadrupedal and bipedal gaits using functional near-infrared spectroscopy in 10 healthy adults. The subjects performed three locomotor tasks where the degree of postural instability varied biomechanically, namely, hand-knee quadrupedal crawling (HKQuad task), upright quadrupedalism using bilateral Lofstrand crutches (UpQuad task), and typical upright bipedalism (UpBi task), on a treadmill. We measured the concentration of oxygenated hemoglobin (oxy-Hb) during the tasks. The oxy-Hb significantly decreased in the SMA during the HKQuad task, whereas it increased during the UpQuad task. No significant responses were observed during the UpBi task. Based on the degree of oxy-Hb responses, we ranked these locomotor tasks as UpQuad > UpBi > HKQuad. The order of the different tasks did not correspond with postural instability of the tasks. However, qualitative inspection of oxy-Hb time courses showed that oxy-Hb waveform patterns differed between upright posture tasks (peak-plateau-trough pattern for the UpQuad and UpBi tasks) and horizontal posture task (downhill pattern for the HKQuad task). Thus, the SMA may contribute to the control of truncal posture accompanying locomotor movements in humans.
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Affiliation(s)
- Arito Yozu
- Department of Rehabilitation Medicine, Graduate School of Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8602, Japan
- Department of Rehabilitation Medicine, Nippon Medical School Chiba-Hokusoh Hospital, 1715 Kamakari, Inzai, Chiba 270-1694, Japan
- Department of Rehabilitation Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Shigeru Obayashi
- Department of Rehabilitation Medicine, Nippon Medical School Chiba-Hokusoh Hospital, 1715 Kamakari, Inzai, Chiba 270-1694, Japan
| | - Katsumi Nakajima
- Department of Physiology, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi, Osakasayama, Osaka 589-8511, Japan
| | - Yukihiro Hara
- Department of Rehabilitation Medicine, Graduate School of Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8602, Japan
- Department of Rehabilitation Medicine, Nippon Medical School Chiba-Hokusoh Hospital, 1715 Kamakari, Inzai, Chiba 270-1694, Japan
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Pereira FV, Oliveira FFD, Schultz RR, Bertolucci PHF. Balance impairment does not necessarily coexist with gait apraxia in mild and moderate Alzheimer's disease. ARQUIVOS DE NEURO-PSIQUIATRIA 2016; 74:450-455. [PMID: 27332069 DOI: 10.1590/0004-282x20160063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 03/22/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To assess correlations among gait apraxia, balance impairment and cognitive performance in mild (AD1, n = 30) and moderate (AD2, n = 30) AD. METHOD The following evaluations were undertaken: gait apraxia (Assessment Walking Skills); balance performance (Berg Balance Scale); Clinical Dementia Rating and Mini-mental State Examination (MMSE). RESULTS While disregarding AD subgroups, Berg Balance Scale and the MMSE correlated significantly with Assessment Walking Skills and 23% of all subjects scored below its cut-off. After stratification, Berg Balance Scale correlated significantly with Assessment Walking Skills in both AD subgroups, and with the MMSE only in AD1. CONCLUSIONS Balance impairment does not necessarily coexist with gait apraxia. Gait apraxia is more prevalent in moderate AD when compared with mild AD.
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Affiliation(s)
- Fernando Vieira Pereira
- Universidade Federal de São Paulo, Universidade Federal de São Paulo, São Paulo SP , Brasil, Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brasil
| | - Fabricio Ferreira de Oliveira
- Universidade Federal de São Paulo, Universidade Federal de São Paulo, São Paulo SP , Brasil, Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brasil
| | - Rodrigo Rizek Schultz
- Universidade Federal de São Paulo, Universidade Federal de São Paulo, São Paulo SP , Brasil, Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brasil
| | - Paulo Henrique Ferreira Bertolucci
- Universidade Federal de São Paulo, Universidade Federal de São Paulo, São Paulo SP , Brasil, Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brasil
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Fling BW, Dale ML, Curtze C, Smulders K, Nutt JG, Horak FB. Associations between mobility, cognition and callosal integrity in people with parkinsonism. NEUROIMAGE-CLINICAL 2016; 11:415-422. [PMID: 27104136 PMCID: PMC4827724 DOI: 10.1016/j.nicl.2016.03.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 02/26/2016] [Accepted: 03/07/2016] [Indexed: 01/15/2023]
Abstract
Falls in people with parkinsonism are likely related to both motor and cognitive impairments. In addition to idiopathic Parkinson's disease (PD), some older adults have lower body parkinsonism (a frontal gait disorder), characterized by impaired lower extremity balance and gait as well as cognition, but without tremor or rigidity. Neuroimaging during virtual gait suggests that interhemispheric, prefrontal cortex communication may be involved in locomotion, but contributions of neuroanatomy connecting these regions to objective measures of gait in people with parkinsonism remains unknown. Our objectives were to compare the integrity of fiber tracts connecting prefrontal and sensorimotor cortical regions via the corpus callosum in people with two types of parkinsonism and an age-matched control group and to relate integrity of these callosal fibers with clinical and objective measures of mobility and cognition. We recruited 10 patients with frontal gait disorders, 10 patients with idiopathic PD and 10 age-matched healthy control participants. Participants underwent cognitive and mobility testing as well as diffusion weighted magnetic resonance imaging to quantify white matter microstructural integrity of interhemispheric fiber tracts. People with frontal gait disorders displayed poorer cognitive performance and a slower, wider-based gait compared to subjects with PD and age-matched control subjects. Despite a widespread network of reduced white matter integrity in people with frontal gait disorders, gait and cognitive deficits were solely related to interhemispheric circuitry employing the genu of the corpus callosum. Current results highlight the importance of prefrontal interhemispheric communication for lower extremity control in neurological patients with cognitive dysfunction. Those with a frontal gait disorder have a slower, wider-based gait compared to idiopathic PD. Gait performance was related to integrity of genu fiber tracts in those with FGD. Prefrontal cortices may become more involved in locomotion with cognitive dysfunction.
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Affiliation(s)
- Brett W Fling
- Department of Neurology, School of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239-3098, USA.
| | - Marian L Dale
- Department of Neurology, School of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239-3098, USA
| | - Carolin Curtze
- Department of Neurology, School of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239-3098, USA
| | - Katrijn Smulders
- Department of Neurology, School of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239-3098, USA
| | - John G Nutt
- Department of Neurology, School of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239-3098, USA
| | - Fay B Horak
- Department of Neurology, School of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239-3098, USA; VA Portland Health Care System, 3710 SW US Veterans Hospital Rd, Portland, OR 97239-9264, USA
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35
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Brust JC, Chamorro A. Anterior Cerebral Artery Disease. Stroke 2016. [DOI: 10.1016/b978-0-323-29544-4.00023-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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36
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Sensory modulation of movement, posture and locomotion. Neurophysiol Clin 2015; 45:255-67. [DOI: 10.1016/j.neucli.2015.09.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 09/16/2015] [Accepted: 09/16/2015] [Indexed: 11/20/2022] Open
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37
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Brugger F, Galovic M, Weder BJ, Kägi G. Supplementary Motor Complex and Disturbed Motor Control - a Retrospective Clinical and Lesion Analysis of Patients after Anterior Cerebral Artery Stroke. Front Neurol 2015; 6:209. [PMID: 26528234 PMCID: PMC4600920 DOI: 10.3389/fneur.2015.00209] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 09/14/2015] [Indexed: 12/19/2022] Open
Abstract
Background Both the supplementary motor complex (SMC), consisting of the supplementary motor area (SMA) proper, the pre-SMA, and the supplementary eye field, and the rostral cingulate cortex are supplied by the anterior cerebral artery (ACA) and are involved in higher motor control. The Bereitschaftspotential (BP) originates from the SMC and reflects cognitive preparation processes before volitional movements. ACA strokes may lead to impaired motor control in the absence of limb weakness and evoke an alien hand syndrome (AHS) in its extreme form. Aim To characterize the clinical spectrum of disturbed motor control after ACA strokes, including signs attributable to AHS and to identify the underlying neuroanatomical correlates. Methods A clinical assessment focusing on signs of disturbed motor control including intermanual conflict (i.e., bilateral hand movements directed at opposite purposes), lack of self-initiated movements, exaggerated grasping, motor perseverations, mirror movements, and gait apraxia was performed. Symptoms were grouped into (A) AHS-specific and (B) non-AHS-specific signs of upper limbs, and (C) gait apraxia. Lesion summation mapping was applied to the patients’ MRI or CT scans to reveal associated lesion patterns. The BP was recorded in two patients. Results Ten patients with ACA strokes (nine unilateral, one bilateral; mean age: 74.2 years; median NIH-SS at admission: 13.0) were included in this case series. In the acute stage, all cases had marked difficulties to perform volitional hand movements, while movements in response to external stimuli were preserved. In the chronic stage (median follow-up: 83.5 days) initiation of voluntary movements improved, although all patients showed persistent signs of disturbed motor control. Impaired motor control is predominantly associated with damaged voxels within the SMC and the anterior and medial cingulate cortex, while lesions within the pre-SMA are specifically related to AHS. No BP was detected over the damaged hemisphere. Conclusion ACA strokes involving the premotor cortices, particularly the pre-SMA, are associated with AHS-specific signs. In the acute phase, motor behavior is characterized by the inability to carry out self-initiated movements. Motor control deficits may persist to a variable degree beyond the acute phase. Alterations of the BP point to an underlying SMC dysfunction in AHS.
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Affiliation(s)
- Florian Brugger
- Klinik für Neurologie, Kantonsspital St. Gallen , St. Gallen , Switzerland ; Sobell Department of Motor Neuroscience and Movement Disorders, University College London , London , UK
| | - Marian Galovic
- Klinik für Neurologie, Kantonsspital St. Gallen , St. Gallen , Switzerland
| | - Bruno J Weder
- Support Center of Advanced Neuroimaging, Inselspital , Bern , Switzerland
| | - Georg Kägi
- Klinik für Neurologie, Kantonsspital St. Gallen , St. Gallen , Switzerland
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Cevallos C, Zarka D, Hoellinger T, Leroy A, Dan B, Cheron G. Oscillations in the human brain during walking execution, imagination and observation. Neuropsychologia 2015; 79:223-32. [PMID: 26164473 DOI: 10.1016/j.neuropsychologia.2015.06.039] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 06/19/2015] [Accepted: 06/23/2015] [Indexed: 01/01/2023]
Abstract
Gait is an essential human activity which organizes many functional and cognitive behaviors. The biomechanical constraints of bipedalism implicating a permanent control of balance during gait are taken into account by a complex dialog between the cortical, subcortical and spinal networks. This networking is largely based on oscillatory coding, including changes in spectral power and phase-locking of ongoing neural activity in theta, alpha, beta and gamma frequency bands. This coding is specifically modulated in actual gait execution and representation, as well as in contexts of gait observation or imagination. A main challenge in integrative neuroscience oscillatory activity analysis is to disentangle the brain oscillations devoted to gait control. In addition to neuroimaging approaches, which have highlighted the structural components of an extended network, dynamic high-density EEG gives non-invasive access to functioning of this network. Here we revisit the neurophysiological foundations of behavior-related EEG in the light of current neuropsychological theoretic frameworks. We review different EEG rhythms emerging in the most informative paradigms relating to human gait and implications for rehabilitation strategies.
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Affiliation(s)
- C Cevallos
- Laboratory of Neurophysiology and Movement Biomechanics, ULB Neuroscience Institut, Université Libre de Bruxelles, CP 640, 50 Avenue Franklin Rooseveltlaan, 1050 Brussels, Belgium
| | - D Zarka
- Laboratory of Neurophysiology and Movement Biomechanics, ULB Neuroscience Institut, Université Libre de Bruxelles, CP 640, 50 Avenue Franklin Rooseveltlaan, 1050 Brussels, Belgium
| | - T Hoellinger
- Laboratory of Neurophysiology and Movement Biomechanics, ULB Neuroscience Institut, Université Libre de Bruxelles, CP 640, 50 Avenue Franklin Rooseveltlaan, 1050 Brussels, Belgium
| | - A Leroy
- Laboratory of Neurophysiology and Movement Biomechanics, ULB Neuroscience Institut, Université Libre de Bruxelles, CP 640, 50 Avenue Franklin Rooseveltlaan, 1050 Brussels, Belgium; Haute Ecole Condorcet, Charleroi, Belgium
| | - B Dan
- Laboratory of Neurophysiology and Movement Biomechanics, ULB Neuroscience Institut, Université Libre de Bruxelles, CP 640, 50 Avenue Franklin Rooseveltlaan, 1050 Brussels, Belgium; Department of Neurology, Hopital Universitaire des Enfants reine Fabiola, Université Libre de Bruxelles, Belgium
| | - G Cheron
- Laboratory of Neurophysiology and Movement Biomechanics, ULB Neuroscience Institut, Université Libre de Bruxelles, CP 640, 50 Avenue Franklin Rooseveltlaan, 1050 Brussels, Belgium; Laboratory of Electrophysiology, Université de Mons-Hainaut, Belgium.
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Toth A, Lovadi E, Komoly S, Schwarcz A, Orsi G, Perlaki G, Bogner P, Sebok A, Kovacs N, Pal E, Janszky J. Cortical involvement during myotonia in myotonic dystrophy: an fMRI study. Acta Neurol Scand 2015; 132:65-72. [PMID: 25630356 DOI: 10.1111/ane.12360] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2014] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Myotonic dystrophy type 1 (DM1) is a common adulthood muscular dystrophy, characterized by muscle wasting, myotonia, and multisystemic manifestations. The phenomenon of involuntary muscle contraction during myotonia offers a unique possibility of investigating brain motor functions. This study explores cortical involvement during grip myotonia in DM1. MATERIALS AND METHODS Sixteen DM1 patients were enrolled in the study. Eight patients had apparent grip myotonia, while eight patients did not (control subjects). All patients underwent functional MRI grip task examination twice: prior a warm-up procedure (myotonia was elicited in patients with apparent grip myotonia) and after a warm-up procedure (myotonia was attenuated in patients with apparent grip myotonia). No myotonia was elicited during either examination in patients without apparent grip myotonia. Cerebral blood oxygen level-dependent (BOLD) signals were compared both between groups with and without apparent myotonia, and between pre- and post-warm-up sessions. RESULTS Significantly higher BOLD signal was found during myotonia phase in patients with apparent grip myotonia compared to corresponding non-myotonia phase of patients without apparent grip myotonia in the supplementary motor area and in the dorsal anterior cingulate cortex. Significant differences in BOLD signal levels of very similar pattern were detected between prewarm-up session myotonia phase and post-warm-up session myotonia absent phase in the group of patients with apparent grip myotonia. CONCLUSION We showed that myotonia is related to cortical function in high-order motor control areas. This cortical involvement is most likely to represent action of inhibitory circuits intending motor termination.
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Affiliation(s)
- A. Toth
- Department of Neurology; University of Pécs; Pécs Hungary
| | - E. Lovadi
- Department of Neurology; University of Pécs; Pécs Hungary
| | - S. Komoly
- Department of Neurology; University of Pécs; Pécs Hungary
| | - A. Schwarcz
- Department of Neurosurgery; University of Pécs; Pécs Hungary
- MTA-PTE Clinical Neuroscience MR Research Group; Pécs Hungary
| | - G. Orsi
- MTA-PTE Clinical Neuroscience MR Research Group; Pécs Hungary
- Diagnostic Center of Pécs; Pécs Hungary
| | - G. Perlaki
- MTA-PTE Clinical Neuroscience MR Research Group; Pécs Hungary
- Diagnostic Center of Pécs; Pécs Hungary
| | - P. Bogner
- Department of Neurosurgery; University of Pécs; Pécs Hungary
- Diagnostic Center of Pécs; Pécs Hungary
| | - A. Sebok
- Department of Neurology; University of Pécs; Pécs Hungary
| | - N. Kovacs
- Department of Neurology; University of Pécs; Pécs Hungary
- MTA-PTE Clinical Neuroscience MR Research Group; Pécs Hungary
| | - E. Pal
- Department of Neurology; University of Pécs; Pécs Hungary
| | - J. Janszky
- Department of Neurology; University of Pécs; Pécs Hungary
- MTA-PTE Clinical Neuroscience MR Research Group; Pécs Hungary
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Carlsen AN, Eagles JS, MacKinnon CD. Transcranial direct current stimulation over the supplementary motor area modulates the preparatory activation level in the human motor system. Behav Brain Res 2014; 279:68-75. [PMID: 25446764 DOI: 10.1016/j.bbr.2014.11.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 10/29/2014] [Accepted: 11/05/2014] [Indexed: 11/16/2022]
Abstract
Transcranial direct current stimulation (tDCS) is a non-invasive stimulation method that can induce transient polarity-specific neuroplastic changes in cortical excitability lasting up to 1h post-stimulation. While excitability changes with stimulation over the primary motor cortex have been well documented, the functional effects of stimulation over premotor regions are less well understood. In the present experiment, we tested how cathodal and anodal tDCS applied over the region of the supplementary motor area (SMA) affected preparation and initiation of a voluntary movement. Participants performed a simple reaction time (RT) task requiring a targeted wrist-extension in response to a go-signal. In 20% of RT trials a startling acoustic stimulus (SAS) was presented 500 ms prior to the "go" signal in order to probe the state of motor preparation. Following the application of cathodal, anodal, or sham tDCS (separate days) over SMA for 10 min, participants performed blocks of RT trials at 10 min intervals. While sham stimulation did not affect RT or incidence of early release by the SAS, cathodal tDCS led to a significant slowing of RT that peaked 10 min after the end of stimulation and was associated with a marked decrease in the incidence of movement release by the SAS. In contrast, anodal tDCS resulted in faster RTs, but the incidence of release was unchanged. These results are consistent with the SMA playing a role in the pre-planning of movements and that modulating its activity with tDCS can lead to polarity-specific changes in motor behavior.
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Affiliation(s)
- Anthony N Carlsen
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.
| | - Jeremy S Eagles
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Colum D MacKinnon
- Department of Neurology, University of Minnesota, Minneapolis, MN, USA
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Jang SH, Seo JP. The distribution of the cortical origin of the corticoreticular pathway in the human brain: A diffusion tensor imaging study. Somatosens Mot Res 2014; 31:204-8. [DOI: 10.3109/08990220.2014.917292] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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42
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Nutt JG. Higher-level gait disorders: an open frontier. Mov Disord 2014; 28:1560-5. [PMID: 24132844 DOI: 10.1002/mds.25673] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 07/26/2013] [Accepted: 08/13/2013] [Indexed: 11/10/2022] Open
Abstract
The term higher-level gait disorders (HLGD) defines a category of balance and gait disorders that are not explained by deficits in strength, tone, sensation, or coordination. HLGD are characterized by various combinations of disequilibrium and impaired locomotion. A plethora of new imaging techniques are beginning to determine the neural circuits that are the basis of these disorders. Although a variety of neurodegenerative and other pathologies can produce HLGD, the most common cause appears to be microvascular disease that causes white-matter lesions and thereby disrupts balance/locomotor circuits.
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Affiliation(s)
- John G Nutt
- Department of Neurology, Oregon Health and Science University, Portland, Oregon, USA
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43
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Aoki Y, Kazui H, Tanaka T, Ishii R, Wada T, Ikeda S, Hata M, Canuet L, Musha T, Matsuzaki H, Imajo K, Yoshiyama K, Yoshida T, Shimizu Y, Nomura K, Iwase M, Takeda M. EEG and Neuronal Activity Topography analysis can predict effectiveness of shunt operation in idiopathic normal pressure hydrocephalus patients. NEUROIMAGE-CLINICAL 2013; 3:522-30. [PMID: 24273735 PMCID: PMC3830071 DOI: 10.1016/j.nicl.2013.10.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 09/30/2013] [Accepted: 10/13/2013] [Indexed: 11/19/2022]
Abstract
Idiopathic normal pressure hydrocephalus (iNPH) is a neuropsychiatric syndrome characterized by gait disturbance, cognitive impairment and urinary incontinence that affect elderly individuals. These symptoms can potentially be reversed by cerebrospinal fluid (CSF) drainage or shunt operation. Prior to shunt operation, drainage of a small amount of CSF or "CSF tapping" is usually performed to ascertain the effect of the operation. Unfortunately, conventional neuroimaging methods such as single photon emission computed tomography (SPECT) and functional magnetic resonance imaging (fMRI), as well as electroencephalogram (EEG) power analysis seem to have failed to detect the effect of CSF tapping on brain function. In this work, we propose the use of Neuronal Activity Topography (NAT) analysis, which calculates normalized power variance (NPV) of EEG waves, to detect cortical functional changes induced by CSF tapping in iNPH. Based on clinical improvement by CSF tapping and shunt operation, we classified 24 iNPH patients into responders (N = 11) and nonresponders (N = 13), and performed both EEG power analysis and NAT analysis. We also assessed correlations between changes in NPV and changes in functional scores on gait and cognition scales before and after CSF tapping. NAT analysis showed that after CSF tapping there was a significant decrease in alpha NPV at the medial frontal cortex (FC) (Fz) in responders, while nonresponders exhibited an increase in alpha NPV at the right dorsolateral prefrontal cortex (DLPFC) (F8). Furthermore, we found correlations between cortical functional changes and clinical symptoms. In particular, delta and alpha NPV changes in the left-dorsal FC (F3) correlated with changes in gait status, while alpha and beta NPV changes in the right anterior prefrontal cortex (PFC) (Fp2) and left DLPFC (F7) as well as alpha NPV changes in the medial FC (Fz) correlated with changes in gait velocity. In addition, alpha NPV changes in the right DLPFC (F8) correlated with changes in WMS-R Mental Control scores in iNPH patients. An additional analysis combining the changes in values of alpha NPV over the left-dorsal FC (∆alpha-F3-NPV) and the medial FC (∆alpha-Fz-NPV) induced by CSF tapping (cut-off value of ∆alpha-F3-NPV + ∆alpha-Fz-NPV = 0), could correctly identified "shunt responders" and "shunt nonresponders" with a positive predictive value of 100% (10/10) and a negative predictive value of 66% (2/3). In contrast, EEG power spectral analysis showed no function related changes in cortical activity at the frontal cortex before and after CSF tapping. These results indicate that the clinical changes in gait and response suppression induced by CSF tapping in iNPH patients manifest as NPV changes, particularly in the alpha band, rather than as EEG power changes. Our findings suggest that NAT analysis can detect CSF tapping-induced functional changes in cortical activity, in a way that no other neuroimaging methods have been able to do so far, and can predict clinical response to shunt operation in patients with iNPH.
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Affiliation(s)
- Yasunori Aoki
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Hiroaki Kazui
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Toshihisa Tanaka
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Ryouhei Ishii
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
- Corresponding author at: Department of Psychiatry, Osaka University Graduate School of Medicine, D3 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan. Tel.: + 81-6-6879-3051; fax: + 81-6-6879-3059.
| | - Tamiki Wada
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Shunichiro Ikeda
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Masahiro Hata
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Leonides Canuet
- UCM-UPM Centre for Biomedical Technology, Department of Cognitive and Computational Neuroscience, Complutense University of Madrid, Madrid, Spain
| | | | | | - Kaoru Imajo
- Nihon Kohden Corporation, Shinjuku, Tokyo, Japan
| | - Kenji Yoshiyama
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Tetsuhiko Yoshida
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yoshiro Shimizu
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Keiko Nomura
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Masao Iwase
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Masatoshi Takeda
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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Whitwell JL, Duffy JR, Strand EA, Machulda MM, Senjem ML, Gunter JL, Kantarci K, Eggers SD, Jack CR, Josephs KA. Neuroimaging comparison of primary progressive apraxia of speech and progressive supranuclear palsy. Eur J Neurol 2012; 20:629-37. [PMID: 23078273 DOI: 10.1111/ene.12004] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Accepted: 09/10/2012] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE Primary progressive apraxia of speech, a motor speech disorder of planning and programming, is a tauopathy that has overlapping histological features with progressive supranuclear palsy. We aimed to compare, for the first time, atrophy patterns, as well as white matter tract degeneration, between these two syndromes. METHODS Sixteen primary progressive apraxia of speech subjects were age- and gender-matched to 16 progressive supranuclear palsy subjects and 20 controls. All subjects were prospectively recruited, underwent neurological and speech evaluations and 3.0-Tesla magnetic resonance imaging. Grey and white matter atrophy was assessed using voxel-based morphometry and atlas-based parcellation, and white matter tract degeneration was assessed using diffusion tensor imaging. RESULTS All progressive supranuclear palsy subjects had typical oculomotor/gait impairments, but none had speech apraxia. Both syndromes showed grey matter loss in supplementary motor area, white matter loss in posterior frontal lobes and degeneration of the body of the corpus callosum. Whilst lateral grey matter loss was focal, involving superior premotor cortex, in primary progressive apraxia of speech, loss was less focal extending into prefrontal cortex in progressive supranuclear palsy. Caudate volume loss and tract degeneration of superior cerebellar peduncles were also observed in progressive supranuclear palsy. Interestingly, area of the midbrain was reduced in both syndromes compared to controls, although this was greater in progressive supranuclear palsy. CONCLUSIONS Although neuroanatomical differences were identified between these distinctive clinical syndromes, substantial overlap was also observed, including midbrain atrophy, suggesting these two syndromes may have common pathophysiological underpinnings.
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Affiliation(s)
- J L Whitwell
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA.
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Lallart E, Jouvent R, Herrmann FR, Beauchet O, Allali G. Gait and motor imagery of gait in early schizophrenia. Psychiatry Res 2012; 198:366-70. [PMID: 22445069 DOI: 10.1016/j.psychres.2011.12.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Revised: 10/05/2011] [Accepted: 12/11/2011] [Indexed: 11/25/2022]
Abstract
Although gait disorders were described in schizophrenia, motor imagery of gait has not yet been studied in this pathology. We compared gait, motor imagery of gait and the difference between these two conditions in patients with schizophrenia and healthy age-matched controls. The mean ± standard deviation (S.D.) of Timed Up and Go (TUG), imagined TUG (iTUG) and delta time (i.e.; difference between TUG and iTUG), was used as outcomes. Covariables include Mini Mental State Examination, the Frontal Assessment Battery (FAB), FAB's subitems, the Positive and Negative Syndrome Scale and the Unified Parkinson's Disease Rating Scale (UPDRS). Seventeen patients with early schizophrenia and 15 healthy age-matched controls were assessed. Schizophrenia patients performed the TUG and the iTUG slower than the controls. Multivariate linear regressions showed that iTUG and delta time were associated with the conflicting instruction of the FAB. The present study provides the first evidence that patients with schizophrenia performed gait and motor imagery of gait slower than healthy controls. These deficits could be in part explained by impaired executive function and specifically by a disturbance in the sensitivity to interference.
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Affiliation(s)
- Elise Lallart
- Emotion Center - CNRS USR 3246, Pitié-Salpêtrière Hospital, Paris, France
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A second case of isolated gait apraxia from an acute unilateral parasagittal lesion. Clin Neurol Neurosurg 2012; 114:823-5. [PMID: 22560156 DOI: 10.1016/j.clineuro.2012.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Accepted: 04/08/2012] [Indexed: 11/20/2022]
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47
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Kwon JW, Park SY, Son SM, Kim CS. Correlation between Assessments of Arm and Leg Ideomotor Apraxia in Hemiplegic Stroke Patients. J Phys Ther Sci 2012. [DOI: 10.1589/jpts.24.187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Jung Won Kwon
- Department of Rehabilitation Science, Graduate School, Daegu University
| | - Sang Young Park
- Department of Rehabilitation Science, Graduate School, Daegu University
| | - Sung Min Son
- Department of Rehabilitation Science, Graduate School, Daegu University
| | - Chung Sun Kim
- Department of Physical Therapy, College of Rehabilitation Science, Daegu University
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48
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Abstract
The precise anatomy and physiology of human walking remains poorly understood. The frontal lobes appear crucial, and, on the basis of clinical observation, contribute to the control of truncal motion, postural responses, and the maintenance of equilibrium and locomotion. The rich repertoire of frontal gait disorders gives some indication of this complexity. Variable combinations of disequilibrium with a wide stance base, increased body sway and falls, loss of control of truncal motion, locomotor disability with gait ignition failure, start hesitation, shuffling, and freezing are encountered in diseases of the frontal lobes. Furthermore, the pattern of gait may change as the frontal disease progresses. The slowness of walking, lack of heel-shin or upper limb ataxia, dysarthria or nystagmus distinguishes the wide stance base from cerebellar gait ataxia. A lively facial expression, normal voluntary movements of the upper limbs, upper motor neuron signs, and the absence of a rest tremor distinguish the hypokinetic elements from Parkinson's disease. Poor truncal mobility, impaired postural responses, and falls after the slightest perturbation eventually make walking impossible even though simple leg movements may still be possible while seated or lying. One or more of these features usually predominates in the initial presentation of a frontal gait syndrome. Accordingly, there is considerable variation in the manner of presentation and evolution of frontal gait disorders. The gait syndrome is accompanied by frontal motor and cognitive changes, which may be subtle or overshadowed by the gait disorder. This complexity of clinical presentation accounts for the plethora of descriptions from "frontal ataxia" to "gait apraxia". As suggested in the original descriptions of frontal ataxia, the spectrum of gait disturbance is likely to be due to damage to frontal cortex and its connections with subcortical structures including the basal ganglia, cerebellum, and the brainstem.
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Affiliation(s)
- Philip D Thompson
- University Department of Medicine, University of Adelaide, Australia.
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49
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Youn J, Cho JW, Lee WY, Kim GM, Kim ST, Kim HT. Diffusion tensor imaging of freezing of gait in patients with white matter changes. Mov Disord 2011; 27:760-4. [PMID: 22162037 DOI: 10.1002/mds.24034] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Revised: 09/19/2011] [Accepted: 10/23/2011] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Freezing of gait is a common and disabling symptom of parkinsonism. However, the corresponding anatomic structures have yet to be clearly elucidated. METHODS We performed diffusion tensor imaging on 40 subjects with white matter changes. We compared apparent diffusion coefficient values and fraction anisotropy values of 7 candidate anatomic structures between 14 patients with freezing of gait (freezing of gait group) and 26 without freezing of gait (control group). RESULTS Fraction anisotropy values of the bilateral pedunculopontine nucleus, bilateral superior premotor cortex, right orbitofrontal area, and left supplement motor area were significantly lower in the freezing of gait group than in the control group. In contrast, there were no significant differences in apparent diffusion coefficient values between freezing of gait and control groups. CONCLUSIONS Our findings suggest that the bilateral pedunculopontine nucleus, bilateral superior premotor cortex, right orbitofrontal area, and left supplement motor area are closely related to freezing of gait.
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Affiliation(s)
- Jinyoung Youn
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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50
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Abstract
Freezing of gait (FoG) is a unique and disabling clinical phenomenon characterised by brief episodes of inability to step or by extremely short steps that typically occur on initiating gait or on turning while walking. Patients with FoG, which is a feature of parkinsonian syndromes, show variability in gait metrics between FoG episodes and a substantial reduction in step length with frequent trembling of the legs during FoG episodes. Physiological, functional imaging, and clinical-pathological studies point to disturbances in frontal cortical regions, the basal ganglia, and the midbrain locomotor region as the probable origins of FoG. Medications, deep brain stimulation, and rehabilitation techniques can alleviate symptoms of FoG in some patients, but these treatments lack efficacy in patients with advanced FoG. A better understanding of the phenomenon is needed to aid the development of effective therapeutic strategies.
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