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Kola S, Rangam RP, Kandadai RM, Alugolu R, Kedasi R, Swamygowda P, Prasad VVSRK, Meka SSL, Fathima ST, Borgohain R. Changes in Optimal Stimulation Frequency with Time for Gait Disturbances in Patients with PD after STN-DBS-A Longitudinal Study. Ann Indian Acad Neurol 2023; 26:401-407. [PMID: 37970314 PMCID: PMC10645258 DOI: 10.4103/aian.aian_95_23] [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: 02/02/2023] [Revised: 03/28/2023] [Accepted: 05/03/2023] [Indexed: 11/17/2023] Open
Abstract
Aim To assess the changes in frequency parameters of STN-DBS stimulation over 6 months required to optimize gait in PD patients. Methods It's a single center, open label longitudinal study of PD patients after STN-DBS with gait disorders. Gait assessment using stand-walk-sit (SWS) test and freezing of gait (FOG) scores were done at baseline and after 6 months. Gait was assessed in five frequencies settings, that is, 60 Hz, 90 Hz, 130 Hz, 180 Hz and stimulation "OFF" during medication ON state. Voltage was maintained. Results Fifteen post-deep brain stimulation (DBS) patients were included. Mean duration after surgery was 3.73 ± 2.82 years. In SWS and FOG at baseline, five patients have good response at 180 Hz frequency, five at 130 Hz, one at 90 Hz, two patients at 60 Hz, one both 60 and 90 Hz, and one at both 90 and 180 HZ. And after 6 months out of the 13 patients who were able to perform the test, four patients had good response at 180 Hz frequency, four at 130 Hz, two at 90 Hz, one each for 60 Hz and battery OFF state, and one for both 130 Hz and 180 Hz. At 6 months, four patients had good response at the same frequency as baseline, while 11 patients have change in frequency from baseline. Conclusion Optimal frequency for gait varies in patients-both low and high frequency may be useful. Optimal frequency for improving gait changes over period of time. Regular assessment and changing frequency may improve gait after DBS.
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Affiliation(s)
- Sruthi Kola
- Department of Neurology, Government Medical College, Ananthapuram, Andhra Pradesh, India
| | - Ravi Prakash Rangam
- Department of Neurology, Government Medical College, Ananthapuram, Andhra Pradesh, India
| | | | - Rajesh Alugolu
- Department of Neurosurgery, Citi Neuro Centre, Telangana, India
| | - Raghuram Kedasi
- Department of Neurosurgery, Nizam’s Institute of Medical Sciences (NIMS), Telangana, India
| | - Pavan Swamygowda
- Department of Neurosurgery, Nizam’s Institute of Medical Sciences (NIMS), Telangana, India
| | - VVSRK Prasad
- Department of Neurology, Citi Neuro Centre, Telangana, India
| | - Sai Sri Lakshmi Meka
- Department of Neurology, Government Medical College, Ananthapuram, Andhra Pradesh, India
| | - Syed T. Fathima
- Department of Neurology, Government Medical College, Ananthapuram, Andhra Pradesh, India
| | - Rupam Borgohain
- Department of Neurology, Citi Neuro Centre, Telangana, India
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Freezing of Gait in Parkinson’s Disease Patients Treated with Bilateral Subthalamic Nucleus Deep Brain Stimulation: A Long-Term Overview. Biomedicines 2022; 10:biomedicines10092214. [PMID: 36140318 PMCID: PMC9496255 DOI: 10.3390/biomedicines10092214] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 09/01/2022] [Accepted: 09/03/2022] [Indexed: 11/16/2022] Open
Abstract
Bilateral subthalamic nucleus deep brain stimulation (STN-DBS) is an effective treatment in advanced Parkinson’s Disease (PD). However, the effects of STN-DBS on freezing of gait (FOG) are still debated, particularly in the long-term follow-up (≥5-years). The main aim of the current study is to evaluate the long-term effects of STN-DBS on FOG. Twenty STN-DBS treated PD patients were included. Each patient was assessed before surgery through a detailed neurological evaluation, including FOG score, and revaluated in the long-term (median follow-up: 5-years) in different stimulation and drug conditions. In the long term follow-up, FOG score significantly worsened in the off-stimulation/off-medication condition compared with the pre-operative off-medication assessment (z = −1.930; p = 0.05) but not in the on-stimulation/off-medication (z = −0.357; p = 0.721). There was also a significant improvement of FOG at long-term assessment by comparing on-stimulation/off-medication and off-stimulation/off-medication conditions (z = −2.944; p = 0.003). These results highlight the possible beneficial long-term effects of STN-DBS on FOG.
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Poláková K, Růžička E, Jech R, Kemlink D, Rusz J, Miletínová E, Brožová H. 3D visual cueing shortens the double support phase of the gait cycle in patients with advanced Parkinson's disease treated with DBS of the STN. PLoS One 2020; 15:e0244676. [PMID: 33382785 PMCID: PMC7774936 DOI: 10.1371/journal.pone.0244676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 12/14/2020] [Indexed: 11/28/2022] Open
Abstract
Background Gait disturbances have emerged as some of the main therapeutic concerns in late-stage Parkinson’s disease (PD) treated with dopaminergic therapy and deep brain stimulation (DBS). External cues may help to overcome freezing of gait (FOG) and improve some of the gait parameters. Aim To evaluate the effect of 3D visual cues and STN-DBS on gait in PD group. Methods We enrolled 35 PD patients treated with DBS of nucleus subthalamicus (STN-DBS). Twenty-five patients (5 females; mean age 58.9 ±6.3) and 25 sex- and age-matched controls completed the gait examination. The gait in 10 patients deteriorated in OFF state. The severity of PD was evaluated using the Unified Parkinson's Disease Rating Scale (UPDRS) and Hoehn and Yahr (HY). The PD group filled the Falls Efficacy Scale-International (FES) and Freezing of Gait Questionnaire (FOGQ). Gait was examined using the GaitRite Analysis System, placed in the middle of the 10m marked path. The PD group was tested without dopaminergic medication with and without visual cueing together with the DBS switched ON and OFF. The setting of DBS was double-blind and performed in random order. Results The UPDRS was 21.9 ±9.5 in DBS ON state and 41.3 ±13.7 in DBS OFF state. HY was 2.5 ±0.6, FES 12.4 ±4.1 and FOGQ 9.4 ±5.7. In the DBS OFF state, PD group walked more slowly with shorter steps, had greater step length variability and longer duration of the double support phase compared to healthy controls. The walking speed and step length increased in the DBS ON state. The double support phase was reduced with 3D visual cueing and DBS; the combination of both cueing and DBS was even more effective. Conclusion Cueing with 3D visual stimuli shortens the double support phase in PD patients treated with DBS-STN. The DBS is more effective in prolonging step length and increasing gait speed. We conclude that 3D visual cueing can improve walking in patients with DBS.
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Affiliation(s)
- Kamila Poláková
- Department of Neurology and Center of Clinical Neuroscience, 1st Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Evžen Růžička
- Department of Neurology and Center of Clinical Neuroscience, 1st Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Robert Jech
- Department of Neurology and Center of Clinical Neuroscience, 1st Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - David Kemlink
- Department of Neurology and Center of Clinical Neuroscience, 1st Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Jan Rusz
- Department of Neurology and Center of Clinical Neuroscience, 1st Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
- Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic
| | - Eva Miletínová
- Department of Neurology and Center of Clinical Neuroscience, 1st Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Hana Brožová
- Department of Neurology and Center of Clinical Neuroscience, 1st Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
- * E-mail:
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Gao C, Liu J, Tan Y, Chen S. Freezing of gait in Parkinson's disease: pathophysiology, risk factors and treatments. Transl Neurodegener 2020; 9:12. [PMID: 32322387 PMCID: PMC7161193 DOI: 10.1186/s40035-020-00191-5] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 03/24/2020] [Indexed: 12/14/2022] Open
Abstract
Background Freezing of gait (FOG) is a common, disabling symptom of Parkinson's disease (PD), but the mechanisms and treatments of FOG remain great challenges for clinicians and researchers. The main focus of this review is to summarize the possible mechanisms underlying FOG, the risk factors for screening and predicting the onset of FOG, and the clinical trials involving various therapeutic strategies. In addition, the limitations and recommendations for future research design are also discussed. Main body In the mechanism section, we briefly introduced the physiological process of gait control and hypotheses about the mechanism of FOG. In the risk factor section, gait disorders, PIGD phenotype, lower striatal DAT uptake were found to be independent risk factors of FOG with consistent evidence. In the treatment section, we summarized the clinical trials of pharmacological and non-pharmacological treatments. Despite the limited effectiveness of current medications for FOG, especially levodopa resistant FOG, there were some drugs that showed promise such as istradefylline and rasagiline. Non-pharmacological treatments encompass invasive brain and spinal cord stimulation, noninvasive repetitive transcranial magnetic stimulation (rTMS) or transcranial direct current stimulation (tDCS) and vagus nerve stimulation (VNS), and physiotherapeutic approaches including cues and other training strategies. Several novel therapeutic strategies seem to be effective, such as rTMS over supplementary motor area (SMA), dual-site DBS, spinal cord stimulation (SCS) and VNS. Of physiotherapy, wearable cueing devices seem to be generally effective and promising. Conclusion FOG model hypotheses are helpful for better understanding and characterizing FOG and they provide clues for further research exploration. Several risk factors of FOG have been identified, but need combinatorial optimization for predicting FOG more precisely. Although firm conclusions cannot be drawn on therapeutic efficacy, the literature suggested that some therapeutic strategies showed promise.
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Affiliation(s)
- Chao Gao
- 1Department of Neurology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Liu
- 1Department of Neurology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuyan Tan
- 1Department of Neurology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shengdi Chen
- 1Department of Neurology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.,2Co-innovation Center of Neuroregeneration, Nantong University, Nantong, Jiangsu Province China
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Kim R, Kim HJ, Shin C, Park H, Kim A, Paek SH, Jeon B. Long-term effect of subthalamic nucleus deep brain stimulation on freezing of gait in Parkinson's disease. J Neurosurg 2019; 131:1797-1804. [PMID: 30641837 DOI: 10.3171/2018.8.jns18350] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 08/24/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Subthalamic nucleus deep brain stimulation (STN DBS) is effective against freezing of gait (FOG) in Parkinson's disease (PD); however, whether this effect persists over the long term is debated. The aim of the current study was to investigate the long-term effect of STN DBS on FOG in patients with PD. METHODS Data on 52 cases in which PD patients received bilateral STN DBS were obtained from a prospective registry. The authors blindly analyzed FOG incidence and its severity from the videotapes of a 5-m walking task at the baseline and at the 1-, 2-, and 5- or 7-year follow-up visits. They also compared the axial score from the Unified Parkinson's Disease Rating Scale (UPDRS) part III, UPDRS part II (UPDRS-II) item 14, and the FOG questionnaire (FOG-Q). Postoperatively, video-based FOG analysis and the axial score were evaluated under 4 conditions (off-medication/off-stimulation, off-medication/on-stimulation, on-medication/off-stimulation, and on-medication/on-stimulation), and UPDRS-II item 14 and the FOG-Q score were evaluated under 2 conditions (off-medication/on-stimulation and on-medication/on-stimulation). RESULTS During the off-medication state, the on-stimulation condition improved FOG outcomes, except for video-based FOG severity, up to the last follow-up compared with the baseline. Video-based FOG outcomes and the axial score during the off-medication state were improved with the on-stimulation condition up to the last follow-up compared with the off-stimulation condition. During the on-medication state, the on-stimulation condition did not improve any FOG outcome compared with the baseline; however, it improved video-based FOG outcomes up to the 2-year follow-up and the axial score up to the last follow-up compared with the off-stimulation condition. CONCLUSIONS Our findings suggest that STN DBS has a long-term effect on FOG in the off-medication state. However, STN DBS did not show a long-term effect on FOG in the on-medication state, although it had a short-term effect until the 2-year follow-up.
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Affiliation(s)
- Ryul Kim
- Departments of1Neurology and
- 2Department of Neurology, Aerospace Medical Center, Republic of Korea Air Force, Cheongju, Chungcheongbuk-do, Korea
| | | | - Chaewon Shin
- 3Department of Neurology, Kyung Hee University Hospital, Seoul; and
| | | | | | - Sun Ha Paek
- 4Neurosurgery, Seoul National University Hospital, College of Medicine
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Huang C, Chu H, Zhang Y, Wang X. Deep Brain Stimulation to Alleviate Freezing of Gait and Cognitive Dysfunction in Parkinson's Disease: Update on Current Research and Future Perspectives. Front Neurosci 2018; 12:29. [PMID: 29503606 PMCID: PMC5821065 DOI: 10.3389/fnins.2018.00029] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 01/15/2018] [Indexed: 01/10/2023] Open
Abstract
Freezing of gait (FOG) is a gait disorder featured by recurrent episodes of temporary gait halting and mainly found in advanced Parkinson's disease (PD). FOG has a severe impact on the quality of life of patients with PD. The pathogenesis of FOG is unclear and considered to be related to several brain areas and neural circuits. Its close connection with cognitive disorder has been proposed and some researchers explain the pathogenesis using the cognitive model theory. FOG occurs concurrently with cognitive disorder in some PD patients, who are poorly responsive to medication therapy. Deep brain stimulation (DBS) proves effective for FOG in PD patients. Cognitive impairment plays a role in the formation of FOG. Therefore, if DBS works by improving the cognitive function, both two challenging conditions can be ameliorated by DBS. We reviewed the clinical studies related to DBS for FOG in PD patients over the past decade. In spite of the varying stimulation parameters used in different studies, DBS of either subthalamic nucleus (STN) or pedunculopontine nucleus (PPN) alone or in combination can improve the symptoms of FOG. Moreover, the treatment efficacy can last for 1–2 years and DBS is generally safe. Although few studies have been conducted concerning the use of DBS for cognitive disorder in FOG patients, the existing studies seem to indicate that PPN is a potential therapeutic target to both FOG and cognitive disorder. However, most of the studies have a small sample size and involve sporadic cases, so it remains uncertain which nucleus is the optimal target of stimulation. Prospective clinical trials with a larger sample size are needed to systematically assess the efficacy of DBS for FOG and cognitive disorder.
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Affiliation(s)
- Chuyi Huang
- Department of Neurology, Shanghai TongRen Hospital, School of Medicine Shanghai, Jiao Tong University, Shanghai, China
| | - Heling Chu
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yan Zhang
- Department of Neurology, Shanghai TongRen Hospital, School of Medicine Shanghai, Jiao Tong University, Shanghai, China
| | - Xiaoping Wang
- Department of Neurology, Shanghai TongRen Hospital, School of Medicine Shanghai, Jiao Tong University, Shanghai, China
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Zhou C, Zhong X, Yang Y, Yang W, Wang L, Zhang Y, Nie K, Xu J, Huang B. Alterations of regional homogeneity in freezing of gait in Parkinson's disease. J Neurol Sci 2018; 387:54-59. [PMID: 29571872 DOI: 10.1016/j.jns.2018.01.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 01/09/2018] [Accepted: 01/17/2018] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Freezing of gait (FOG) is a serious complication in patients with Parkinson's disease (PD), and is more common in the late state of the disease. The high risk of falling in patients with FOG impacts their quality of life. OBJECTIVE To explore altered neuroactivity related to cognitive and executive function of PD patients with FOG. METHODS Fourteen PD patients with FOG (FOG+), 20 PD patients without FOG (FOG-), and 18 normal controls (NC) were enrolled. Functional MRI data of all PD patients were collected during OFF medication state. Data were analyzed using software of DPARSF and REST. Resting brain activity was measured by regional homogeneity (ReHo). ANOVA test was performed for ReHo among FOG, PD, and NC groups. RESULTS ReHo alterations of left supplementary motor area (SMA) (Brodmann 6), left superior frontal region (Brodmann 9), and the right putamen (Brodmann 48) were significantly different among the three groups. The ReHo values within left SMA (Brodmann 6) and left superior frontal region (Brodmann 9) were significantly decreased in FOG+ patients compared with FOG- patients. CONCLUSION Changes in neural hypoactivity within the frontal region and SMA appear to be associated with FOG in PD patients, which suggests that the mechanism underlying FOG may relate to disruption of execution and cognition.
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Affiliation(s)
- Caihong Zhou
- Department of Radiology, Guangdong Academy of Medical Sciences, Guangdong General Hospital, Guangzhou, China
| | - Xiaoling Zhong
- Department of Radiology, Shenzhen People's Hospital, 2nd Clinical Medical College of Jinan University, Shenzhen, China
| | - Yongzhe Yang
- School of Medicine, South China University of Technology, Guangzhou, China
| | - Wanqun Yang
- Department of Radiology, Guangdong Academy of Medical Sciences, Guangdong General Hospital, Guangzhou, China
| | - Lijuan Wang
- Department of Neurology, Guangdong Academy of Medical Sciences, Guangdong General Hospital, Guangzhou, China
| | - Yuhu Zhang
- Department of Neurology, Guangdong Academy of Medical Sciences, Guangdong General Hospital, Guangzhou, China
| | - Kun Nie
- Department of Neurology, Guangdong Academy of Medical Sciences, Guangdong General Hospital, Guangzhou, China
| | - Jianmin Xu
- Department of Radiology, Shenzhen People's Hospital, 2nd Clinical Medical College of Jinan University, Shenzhen, China
| | - Biao Huang
- Department of Radiology, Guangdong Academy of Medical Sciences, Guangdong General Hospital, Guangzhou, China.
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Lehocky CA, Fellows-Mayle W, Engh JA, Riviere CN. Tip Design for Safety of Steerable Needles for Robot-Controlled Brain Insertion. ROBOTIC SURGERY : RESEARCH AND REVIEWS 2017; 4:107-114. [PMID: 29170740 PMCID: PMC5695876 DOI: 10.2147/rsrr.s141085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Current practice in neurosurgical needle insertion is limited by the straight trajectories inherent with rigid probes. One technique allowing curvilinear trajectories involves flexible bevel-tipped needles, which bend during insertion due to their asymmetry. In the brain, safety will require avoidance of the sharp tips often used in laboratory studies, in favor of a more rounded profile. Steering performance, on the other hand, requires maximal asymmetry. Design of safe bevel-tipped brain needles thus involves management of this tradeoff by adjusting needle gauge, bevel angle, and fillet (or tip) radius to arrive at a design that is suitably asymmetrical while producing strain, strain rate, and stress below the levels that would damage brain tissue. Methods Designs with a variety of values of needle radius, bevel angle, and fillet radius were evaluated in finite-element simulations of simultaneous insertion and rotation. Brain tissue was modeled as a hyperelastic, linear viscoelastic material. Based on the literature available, safety thresholds of 0.19 strain, 10 s-1 strain rate, and 120 kPa stress were used. Safe values of needle radius, bevel angle, and fillet radius were selected, along with an appropriate velocity envelope for safe operation. The resulting needle was fabricated and compared with a Sedan side-cutting brain biopsy needle in a study in the porcine model in vivo (N=3). Results The prototype needle selected was 1.66 mm in diameter, with bevel angle of 10° and fillet radius of 0.25 mm. Upon examination of postoperative CT and histological images, no differences in tissue trauma or hemorrhage were noted between the prototype needle and the Sedan needle. Conclusions The study indicates a general design technique for safe bevel-tipped brain needles based on comparison with relevant damage thresholds for strain, strain rate, and stress. The full potential of the technique awaits the determination of more exact safety thresholds.
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Affiliation(s)
- Craig A Lehocky
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | - Wendy Fellows-Mayle
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Johnathan A Engh
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Cameron N Riviere
- The Robotics Institute, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
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Caligiore D, Helmich RC, Hallett M, Moustafa AA, Timmermann L, Toni I, Baldassarre G. Parkinson's disease as a system-level disorder. NPJ PARKINSONS DISEASE 2016; 2:16025. [PMID: 28725705 PMCID: PMC5516580 DOI: 10.1038/npjparkd.2016.25] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 09/20/2016] [Accepted: 10/11/2016] [Indexed: 01/08/2023]
Abstract
Traditionally, the basal ganglia have been considered the main brain region implicated in Parkinson’s disease. This single area perspective gives a restricted clinical picture and limits therapeutic approaches because it ignores the influence of altered interactions between the basal ganglia and other cerebral components on Parkinsonian symptoms. In particular, the basal ganglia work closely in concert with cortex and cerebellum to support motor and cognitive functions. This article proposes a theoretical framework for understanding Parkinson’s disease as caused by the dysfunction of the entire basal ganglia–cortex–cerebellum system rather than by the basal ganglia in isolation. In particular, building on recent evidence, we propose that the three key symptoms of tremor, freezing, and impairments in action sequencing may be explained by considering partially overlapping neural circuits including basal ganglia, cortical and cerebellar areas. Studying the involvement of this system in Parkinson’s disease is a crucial step for devising innovative therapeutic approaches targeting it rather than only the basal ganglia. Possible future therapies based on this different view of the disease are discussed.
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Affiliation(s)
- Daniele Caligiore
- Laboratory of Computational Embodied Neuroscience (LOCEN), Istituto di Scienze e Tecnologie della Cognizione, Consiglio Nazionale delle Ricerche (ISTC-CNR), Roma, Italy
| | - Rick C Helmich
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, The Netherlands
| | - Mark Hallett
- National Institute of Neurological Disorders and Stroke (NINDS), Medical Neurology Branch, Bethesda, MD, USA
| | | | | | - Ivan Toni
- Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Gianluca Baldassarre
- Laboratory of Computational Embodied Neuroscience (LOCEN), Istituto di Scienze e Tecnologie della Cognizione, Consiglio Nazionale delle Ricerche (ISTC-CNR), Roma, Italy
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Schlenstedt C, Shalash A, Muthuraman M, Falk D, Witt K, Deuschl G. Effect of high-frequency subthalamic neurostimulation on gait and freezing of gait in Parkinson's disease: a systematic review and meta-analysis. Eur J Neurol 2016; 24:18-26. [PMID: 27766724 DOI: 10.1111/ene.13167] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 08/29/2016] [Indexed: 01/18/2023]
Abstract
The aim of this meta-analysis was to summarize the short- and long-term effects of bilateral deep brain stimulation of the subthalamic nucleus (STN-DBS) on gait and freezing of gait (FOG) in Parkinson's disease and to detect predictors of post-stimulation outcome. A comprehensive review of the literature was conducted up to October 2015 using Medline Ovid databases for studies analyzing the effect of bilateral STN-DBS on FOG and/or gait. Sixteen studies with available data for the gait item (no. 29) of the Unified Parkinson's Disease Rating Scale (UPDRS) and six studies with the FOG item (no. 14) were included. Data were summarized for the following follow-up periods: 6-15, 24-48 and >48 months. For the medication (Med)-Off/stimulation(Stim)-On condition compared with baseline Med-Off, STN-DBS significantly improved gait on average from 2.43 to 0.96, 2.53 to 1.31 and 2.56 to 1.40 points at 6-15, 24-48 and >48 months, respectively (P < 0.05). Pre-operative levodopa responsiveness of UPDRS-III and Med-Off severity of gait were the predictors of this beneficial effect. STN-DBS significantly improved FOG for the Med-Off/Stim-On condition compared with baseline on average from 2.26 to 0.82, 2.43 to 1.13 and 2.48 to 1.38 points at 6-15, 24-48 and >48 months, respectively (P < 0.05). There was no significant effect in the Med-On/Stim-On condition. This meta-analysis showed a robust improvement of gait and FOG by STN-DBS for more than 4 years in the Med-Off/Stim-On condition. No beneficial effect was found for the On state of medication. Pre-operative levodopa responsiveness of global motor performance (UPDRS-III) is the strongest predictor of the effect of deep brain stimulation on gait.
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Affiliation(s)
- C Schlenstedt
- Department of Neurology, Christian-Albrechts-University, Kiel, Germany
| | - A Shalash
- Department of Neurology, Christian-Albrechts-University, Kiel, Germany.,Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - M Muthuraman
- Department of Neurology, Christian-Albrechts-University, Kiel, Germany.,Department of Neurology, Johannes Gutenberg University, Mainz, Germany
| | - D Falk
- Department of Neurosurgery, Christian-Albrechts-University, Kiel, Germany
| | - K Witt
- Department of Neurology, Christian-Albrechts-University, Kiel, Germany
| | - G Deuschl
- Department of Neurology, Christian-Albrechts-University, Kiel, Germany
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Benba A, Jilbab A, Hammouch A. Discriminating Between Patients With Parkinson's and Neurological Diseases Using Cepstral Analysis. IEEE Trans Neural Syst Rehabil Eng 2016; 24:1100-1108. [PMID: 26929057 DOI: 10.1109/tnsre.2016.2533582] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In this paper, we wanted to discriminate between two groups of patients (patients who suffer from Parkinson's disease and patients who suffer from other neurological disorders). We collected a variety of voice samples from 50 subjects using different recording devices in different conditions. Subsequently, we analyzed and extracted features from these samples using three different Cepstral techniques; Mel frequency cepstral coefficients (MFCC), perceptual linear prediction (PLP), and ReAlitive SpecTrAl PLP (RASTA-PLP). For classification we used leave one subject out validation scheme along with five different supervised learning classifiers. The best obtained result was 90% using the first 11 coefficients of the PLP and linear SVM kernels.
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12
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Therapy-resistant symptoms in Parkinson’s disease. J Neural Transm (Vienna) 2015; 123:19-30. [DOI: 10.1007/s00702-015-1463-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 09/15/2015] [Indexed: 12/25/2022]
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Lehocky CA, Riviere CN. Hyper- and viscoelastic modeling of needle and brain tissue interaction. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2014:6530-3. [PMID: 25571492 DOI: 10.1109/embc.2014.6945124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Deep needle insertion into brain is important for both diagnostic and therapeutic clinical interventions. We have developed an automated system for robotically steering flexible needles within the brain to improve targeting accuracy. In this work, we have developed a finite element needle-tissue interaction model that allows for the investigation of safe parameters for needle steering. The tissue model implemented contains both hyperelastic and viscoelastic properties to simulate the instantaneous and time-dependent responses of brain tissue. Several needle models were developed with varying parameters to study the effects of the parameters on tissue stress, strain and strain rate during needle insertion and rotation. The parameters varied include needle radius, bevel angle, bevel tip fillet radius, insertion speed, and rotation speed. The results will guide the design of safe needle tips and control systems for intracerebral needle steering.
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Vercruysse S, Vandenberghe W, Münks L, Nuttin B, Devos H, Nieuwboer A. Effects of deep brain stimulation of the subthalamic nucleus on freezing of gait in Parkinson's disease: a prospective controlled study. J Neurol Neurosurg Psychiatry 2014; 85:871-7. [PMID: 24396010 DOI: 10.1136/jnnp-2013-306336] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Freezing of gait (FOG) is a debilitating gait disorder in Parkinson's disease (PD) with partial responsiveness to dopaminergic medication. To date, notions about the effects of subthalamic deep brain stimulation (STN-DBS) on FOG remain controversial. OBJECTIVES To compare the effects of bilateral STN-DBS and continued best medical treatment (BMT) on FOG occurrence, FOG severity and clinical outcomes in PD patients at 6 and 12 months follow-up. METHODS In this prospective, controlled study, 41 PD patients with at least 5 years disease duration participated. Twenty-four subjects (20 with FOG) were treated with STN-DBS and seventeen (15 with FOG) continued BMT. The primary outcome was the New Freezing of Gait Questionnaire (NFOGQ) at 6 months postsurgery. Other outcomes were the NFOGQ at 12 months and clinical outcomes (Unified Parkinson's Disease Rating Scale III (UPDRS III), timed gait, falls and quality of life) at both time points. RESULTS STN-DBS increased the likelihood to convert from being a freezer to a non-freezer at 6 and 12 months follow-up (relative risk reduction=0.4). However, 45% of baseline freezers still experienced FOG 6 and 12 months postsurgery although with reduced severity. Three baseline non-freezers (1/2 BMT-treated, 2/4 STN-DBS-treated) developed FOG during follow-up. STN-DBS-induced benefits on FOG were mostly mediated by baseline levodopa equivalent dose, altered medication-intake and reduced motor fluctuations. CONCLUSIONS In contrast to continued BMT, STN-DBS reduced FOG occurrence and severity at 6 months postsurgery with largely sustained effects at 12 months follow-up. Longer follow-up periods are needed to test whether FOG improvements after STN-DBS persist with disease progression.
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Affiliation(s)
- S Vercruysse
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - W Vandenberghe
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | - L Münks
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - B Nuttin
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
| | - H Devos
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - A Nieuwboer
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
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Ebersbach G, Moreau C, Gandor F, Defebvre L, Devos D. Clinical syndromes: Parkinsonian gait. Mov Disord 2014; 28:1552-9. [PMID: 24132843 DOI: 10.1002/mds.25675] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 08/09/2013] [Accepted: 08/16/2013] [Indexed: 01/06/2023] Open
Abstract
Disturbances of gait manifest in almost all cases of Parkinson's disease (PD), often leading to loss of mobility and increased mortality. In this review a clinically oriented approach to gait disorders in different stages of PD is presented. In addition, interactions between motor behavior and mental processing will be discussed. Analyzing the clinical features of gait can be helpful to differentiate PD from atypical forms of parkinsonism. Bedside tests to distinguish parkinsonian gait disorders are reviewed. There is still an unmet need to effectively treat complex gait disturbances, which are frequently not responsive to dopamine replacement medication. We thus present current approaches for the management of dopa-refractory gait disorders.
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Shine JM, Handojoseno AMA, Nguyen TN, Tran Y, Naismith SL, Nguyen H, Lewis SJG. Abnormal patterns of theta frequency oscillations during the temporal evolution of freezing of gait in Parkinson's disease. Clin Neurophysiol 2013; 125:569-76. [PMID: 24099920 DOI: 10.1016/j.clinph.2013.09.006] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 09/10/2013] [Accepted: 09/11/2013] [Indexed: 01/22/2023]
Abstract
OBJECTIVE We sought to characterize the electrophysiological signature of Freezing of gait in Parkinson's disease. METHODS We examined 24 patients with idiopathic Parkinson's disease and significant freezing of gait as they performed a series of timed up-and-go tasks in their 'off' state while electroencephalographic data was collected from four scalp leads. Fast Fourier Transformation was utilized to explore the power spectral density between periods of normal walking and periods of freezing, as well as during the transition between the two states. In addition, Cross Spectrum and Cross Frequency analyses were used to explore the role of impaired temporal and spatial connectivity. RESULTS When compared to walking, episodes of freezing were associated with a significant increase in theta band power within the central and frontal leads. The transition from normal walking to freezing of gait was also associated with increased theta frequency coupling between the central and frontal leads, along with an increase in cross-frequency coupling in the central lead. CONCLUSIONS Episodes of freezing of gait in Parkinson's disease are associated with abnormal oscillatory activity in the brain. SIGNIFICANCE These results provide novel insights into the pattern of spatiotemporal dynamics underlying freezing of gait and may provide a potential means for therapeutic prediction and alleviation of freezing episodes in susceptible patients.
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Affiliation(s)
- J M Shine
- Parkinson's Disease Research Clinic, Brain and Mind Research Institute, The University of Sydney, NSW, Australia.
| | - A M A Handojoseno
- Centre for Health Technologies, University of Technology Sydney, NSW, Australia
| | - T N Nguyen
- Centre for Health Technologies, University of Technology Sydney, NSW, Australia
| | - Y Tran
- Centre for Health Technologies, University of Technology Sydney, NSW, Australia
| | - S L Naismith
- Parkinson's Disease Research Clinic, Brain and Mind Research Institute, The University of Sydney, NSW, Australia
| | - H Nguyen
- Centre for Health Technologies, University of Technology Sydney, NSW, Australia
| | - S J G Lewis
- Parkinson's Disease Research Clinic, Brain and Mind Research Institute, The University of Sydney, NSW, Australia.
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Shine JM, Moustafa AA, Matar E, Frank MJ, Lewis SJG. The role of frontostriatal impairment in freezing of gait in Parkinson's disease. Front Syst Neurosci 2013; 7:61. [PMID: 24109438 PMCID: PMC3790147 DOI: 10.3389/fnsys.2013.00061] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 09/13/2013] [Indexed: 11/25/2022] Open
Abstract
Freezing of gait (FOG) is a disabling symptom of advanced Parkinson's disease (PD) that leads to an increased risk of falls and nursing home placement. Interestingly, multiple lines of evidence suggest that the manifestation of FOG is related to specific deficits in cognition, such as set shifting and the ability to process conflict-related signals. These findings are consistent with the specific patterns of abnormal cortical processing seen during functional neuroimaging experiments of FOG, implicating increased neural activation within cortical structures underlying cognition, such as the Cognitive Control Network. In addition, these studies show that freezing episodes are associated with abnormalities in the BOLD response within key structures of the basal ganglia, such as the striatum and the subthalamic nucleus. In this article, we discuss the implications of these findings on current models of freezing behavior and propose an updated model of basal ganglia impairment during FOG episodes that integrates the neural substrates of freezing from the cortex and the basal ganglia to the cognitive dysfunctions inherent in the condition.
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Affiliation(s)
- James M Shine
- Parkinson's Disease Clinic, Brain and Mind Research Institute, The University of Sydney Sydney, NSW, Australia
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Mandal I, Sairam N. Accurate telemonitoring of Parkinson's disease diagnosis using robust inference system. Int J Med Inform 2013. [DOI: 10.1016/j.ijmedinf.2012.10.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Lenz JD, Lobo MK. Optogenetic insights into striatal function and behavior. Behav Brain Res 2013; 255:44-54. [PMID: 23628212 DOI: 10.1016/j.bbr.2013.04.018] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Revised: 04/10/2013] [Accepted: 04/15/2013] [Indexed: 10/26/2022]
Abstract
Recent breakthroughs in optogenetic technologies to alter neuronal firing and function with light, combined with cell type-specific transgenic animal lines, has led to important insights into the function of distinct neuronal cell subtypes and afferent connections in the heterogeneously complex striatum. A vital part of the basal ganglia, the striatum is heavily implicated in both motor control and motivation-based behavior; as well as in neurological disorders and psychiatric diseases including Parkinson's Disease, Huntington's Disease, drug addiction, depression, and schizophrenia. Researchers are able to manipulate firing and cell signaling with temporal precision using optogenetics in the two striatal medium spiny neuron (MSN) subpopulations, the striatal interneurons, and striatal afferents. These studies confirmed the classical hypothesis of movement control and reward seeking behavior through direct versus indirect pathway MSNs; illuminated a selective role for TANs in cocaine reward; dissected the roles of glutamatergic and dopaminergic inputs to striatum in reward; and highlighted a role for striatal signaling molecules including an adrenergic G-protein coupled receptor in reward and the rho-GTPase Rac1 in cocaine reward and cocaine induced structural plasticity. This review focuses on how the evolving optogenetic toolbox provides insight into the distinct behavioral roles of striatal cell subpopulations and striatal afferents, which has clinically relevant implications into neurological disorders and psychiatric disease.
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Affiliation(s)
- Jeffrey D Lenz
- Department of Anatomy and Neurobiology, Program in Neuroscience, University of Maryland School of Medicine, Baltimore, MD 21201, USA
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