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Klucken J, Winkler J, Krüger R, Jost W. [The history of Freezing-of-gait in Parkinson's disease - from phenomena to symptom]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2020; 88:573-581. [PMID: 32957142 DOI: 10.1055/a-1227-6258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The background of the freezing-of-gait (FOG) phenomenon in Parkinson's syndrome is presented in this review. The following issues are addressed: characterization of the symptom freezing and its subtypes that challenge standardized diagnostic procedures; available assessment methods generating freezing-related parameters that not only support clinical studies but can also be applied in everyday care, and current therapy options. FOG exists in different subtypes, and clinical and diagnostic definitions are limited by subjective characterization and semi-standardized tests. FOG-specific drug options are not existing, apart from the optimization of dopaminergic medication, which may also be due to the poor discriminatory power of standardized diagnostics. This is also true for deep brain stimulation. Both of these therapeutic options may be due not only to the complex neural network alterations as a motor-control correlate of FOG, but also because of challenging diagnostic assessments methodologies. Innovative, wearable, sensor-based diagnostic strategies are currently being developed, and supportive therapies using tools and technologies focusing on 'cueing' are becoming increasingly well accepted. Even though high level evidence is missing, they provide a helpful treatment option for individualized therapy. It can be assumed that these options will become particularly popular due to technological progress and likely alter the everyday treatment challenges faced by doctors and therapists.
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Affiliation(s)
- Jochen Klucken
- Molekulare Neurologie, Universitätsklinikum Erlangen; Fraunhofer-Institut für Integrierte Schaltungen IIS, Erlangen; Medical Valley Digital Health Application Center, Bamberg
| | - Juergen Winkler
- Molekular-Neurologische Abteilung, Universitätsklinikum Erlangen
| | - Rejko Krüger
- Universite du Luxembourg, Clinical and Experimental Neuroscience; Luxembourg Institute for Health (LIH), Transversal Translational Medicine
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Weiss D, Schoellmann A, Fox MD, Bohnen NI, Factor SA, Nieuwboer A, Hallett M, Lewis SJG. Freezing of gait: understanding the complexity of an enigmatic phenomenon. Brain 2020; 143:14-30. [PMID: 31647540 DOI: 10.1093/brain/awz314] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 08/07/2019] [Accepted: 08/16/2019] [Indexed: 12/15/2022] Open
Abstract
Diverse but complementary methodologies are required to uncover the complex determinants and pathophysiology of freezing of gait. To develop future therapeutic avenues, we need a deeper understanding of the disseminated functional-anatomic network and its temporally associated dynamic processes. In this targeted review, we will summarize the latest advances across multiple methodological domains including clinical phenomenology, neurogenetics, multimodal neuroimaging, neurophysiology, and neuromodulation. We found that (i) locomotor network vulnerability is established by structural damage, e.g. from neurodegeneration possibly as result from genetic variability, or to variable degree from brain lesions. This leads to an enhanced network susceptibility, where (ii) modulators can both increase or decrease the threshold to express freezing of gait. Consequent to a threshold decrease, (iii) neuronal integration failure of a multilevel brain network will occur and affect one or numerous nodes and projections of the multilevel network. Finally, (iv) an ultimate pathway might encounter failure of effective motor output and give rise to freezing of gait as clinical endpoint. In conclusion, we derive key questions from this review that challenge this pathophysiological view. We suggest that future research on these questions should lead to improved pathophysiological insight and enhanced therapeutic strategies.
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Affiliation(s)
- Daniel Weiss
- Centre for Neurology, Department for Neurodegenerative Diseases, and Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Anna Schoellmann
- Centre for Neurology, Department for Neurodegenerative Diseases, and Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Michael D Fox
- Berenson-Allen Center, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical Center, Boston, MA, USA.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Nicolaas I Bohnen
- Departments of Radiology and Neurology, University of Michigan, Ann Arbor, MI, USA; Veterans Administration Ann Arbor Healthcare System, Ann Arbor, MI, USA; Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, MI, USA
| | - Stewart A Factor
- Department of Neurology, Emory School of Medicine, Atlanta, GA, USA
| | - Alice Nieuwboer
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Mark Hallett
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Simon J G Lewis
- Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, Australia
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Barbe MT, Tonder L, Krack P, Debû B, Schüpbach M, Paschen S, Dembek TA, Kühn AA, Fraix V, Brefel-Courbon C, Wojtecki L, Maltête D, Damier P, Sixel-Döring F, Weiss D, Pinsker M, Witjas T, Thobois S, Schade-Brittinger C, Rau J, Houeto JL, Hartmann A, Timmermann L, Schnitzler A, Stoker V, Vidailhet M, Deuschl G. Deep Brain Stimulation for Freezing of Gait in Parkinson's Disease With Early Motor Complications. Mov Disord 2019; 35:82-90. [PMID: 31755599 DOI: 10.1002/mds.27892] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 08/08/2019] [Accepted: 08/26/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Effects of DBS on freezing of gait and other axial signs in PD patients are unclear. OBJECTIVE Secondary analysis to assess whether DBS affects these symptoms within a large randomized controlled trial comparing DBS of the STN combined with best medical treatment and best medical treatment alone in patients with early motor complications (EARLYSTIM-trial). METHODS One hundred twenty-four patients were randomized in the stimulation group and 127 patients in the best medical treatment group. Presence of freezing of gait was assessed in the worst condition based on item-14 of the UPDRS-II at baseline and follow-up. The posture, instability, and gait-difficulty subscore of the UPDRS-III, and a gait test including quantification of freezing of gait and number of steps, were performed in both medication-off and medication-on conditions. RESULTS Fifty-two percent in both groups had freezing of gait at baseline based on UPDRS-II. This proportion decreased in the stimulation group to 34%, but did not change in the best medical treatment group at 24 months (P = 0.018). The steps needed to complete the gait test decreased in the stimulation group and was superior to the best medical treatment group (P = 0.016). The axial signs improved in the stimulation group compared to the best medical treatment group (P < 0.01) in both medication-off and medication-on conditions. CONCLUSIONS Within the first 2 years of DBS, freezing of gait and other axial signs improved in the medication-off condition compared to best medical treatment in these patients. © 2019 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Michael T Barbe
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | | | - Paul Krack
- Department of Neurology, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Bettina Debû
- Université Grenoble Alpes, INSERM 1216, Grenoble Institut Neurosciences, Grenoble, France; Neurology Department, Grenoble University Hospital, Grenoble, France
| | - Michael Schüpbach
- Department of Neurology, University Hospital Bern and University of Bern, Bern, Switzerland.,Assistance-Publique Hôpitaux de Paris; Centre d'Investigation Clinique 9503, Institut du Cerveau et de la Moelle épinière; Département de Neurologie, Université Pierre et Marie Curie-Paris 6 et INSERM, CHU Pitié-Salpêtrière, Paris, France.,Institute of Neurology, Konolfingen, Switzerland
| | - Steffen Paschen
- Department of Neurology, UKSH, Kiel Campus Christian-Albrechts-University, Kiel, Germany
| | - Till A Dembek
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Andrea A Kühn
- Department of Neurology, Charité-Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - Valerie Fraix
- Université Grenoble Alpes, INSERM 1216, Grenoble Institut Neurosciences, Grenoble, France; Neurology Department, Grenoble University Hospital, Grenoble, France.,Neurology Department, Grenoble University Hospital, Grenoble, France
| | | | - Lars Wojtecki
- Institute of Clinical Neuroscience and Medical Psychology, and Department of Neurology, Heinrich-Heine University Duesseldorf, Duesseldorf, Germany
| | - David Maltête
- Department of Neurology, Rouen University Hospital and University of Rouen, Rouen, France; INSERM U1239, Laboratory of Neuronal and Neuroendocrine Differentiation and Communication, Mont-Saint-Aignan, France
| | | | | | - Daniel Weiss
- Centre of Neurology, Department for Neurodegenerative Diseases, and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Marcus Pinsker
- Division of Stereotactic and Functional Neurosurgery, University Medical Center, Freiburg, Freiburg, Germany
| | - Tatiana Witjas
- Department of Neurology, Timone University Hospital, UMR 7289, CNRS Marseille, Marseille, France
| | - Stephane Thobois
- Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Centre Expert Parkinson, Bron, France; Université Lyon, Université Claude Bernard Lyon 1, Faculté de Médecine Lyon Sud Charles Mérieux, Oullins, France
| | | | - Jörn Rau
- The Coordinating Center for Clinical Trials, Philipps University, Marburg, Germany
| | - Jean-Luc Houeto
- Department of Neurology, CIC-INSERM 1402, CHU of Poitiers, University of Poitiers, Poitiers, France
| | - Andreas Hartmann
- Assistance-Publique Hôpitaux de Paris; Centre d'Investigation Clinique 9503, Institut du Cerveau et de la Moelle épinière; Département de Neurologie, Université Pierre et Marie Curie-Paris 6 et INSERM, CHU Pitié-Salpêtrière, Paris, France
| | - Lars Timmermann
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Universitätsklinikum Giessen und Marburg, Marburg Campus, Marburg, Germany
| | - Alfons Schnitzler
- Institute of Clinical Neuroscience and Medical Psychology, and Department of Neurology, Heinrich-Heine University Duesseldorf, Duesseldorf, Germany
| | | | - Marie Vidailhet
- Sorbonne Université, ICM UMR1127, INSERM &1127, CNRS 7225, Department of Neurology, Salpêtriere University Hospital, AP-HP, Paris, France
| | - Günther Deuschl
- Department of Neurology, UKSH, Kiel Campus Christian-Albrechts-University, Kiel, Germany
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Fonoff ET, de Lima-Pardini AC, Coelho DB, Monaco BA, Machado B, Pinto de Souza C, Dos Santos Ghilardi MG, Hamani C. Spinal Cord Stimulation for Freezing of Gait: From Bench to Bedside. Front Neurol 2019; 10:905. [PMID: 31507514 PMCID: PMC6718563 DOI: 10.3389/fneur.2019.00905] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 08/05/2019] [Indexed: 12/13/2022] Open
Abstract
Spinal cord stimulation (SCS) has been used for the treatment of chronic pain for nearly five decades. With a high degree of efficacy and a low incidence of adverse events, it is now considered to be a suitable therapeutic alternative in most guidelines. Experimental studies suggest that SCS may also be used as a therapy for motor and gait dysfunction in parkinsonian states. The most common and disabling gait dysfunction in patients with Parkinson's disease (PD) is freezing of gait (FoG). We review the evolution of SCS for gait disorders from bench to bedside and discuss potential mechanisms of action, neural substrates, and clinical outcomes.
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Affiliation(s)
- Erich Talamoni Fonoff
- Hospital Israelita Albert Einstein, São Paulo, Brazil.,Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Andrea C de Lima-Pardini
- Laboratory of Integrative Motor Behaviour, Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
| | - Daniel Boari Coelho
- Human Motor Systems Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil.,Biomedical Engineering, Federal University of ABC, Santo André, Brazil
| | - Bernardo Assumpção Monaco
- Department of Neurology, University of São Paulo, São Paulo, Brazil.,Neurosurgery, Association for Assistance of Disabled Children (AACD), São Paulo, Brazil
| | | | | | | | - Clement Hamani
- Division of Neurosurgery, Harquail Centre for Neuromodulation, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
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