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Welter ML, Lehongre K, Faillot M, Collomb-Clerc A, Belaid H, Lau B, Karachi C. Virtual walking through a doorway promotes a beta-gamma power imbalance in the subthalamic nucleus in Parkinson's disease. Clin Neurophysiol 2024; 162:28-30. [PMID: 38554472 DOI: 10.1016/j.clinph.2024.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 03/14/2024] [Accepted: 03/14/2024] [Indexed: 04/01/2024]
Affiliation(s)
- Marie-Laure Welter
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, Inserm, CNRS, APHP, Hôpital Pitié-Salpêtrière, Paris, France; PANAM Platform, CENIR, ICM, Paris, France; Neurophysiology Department, Rouen University Hospital, CHU Rouen, Rouen, France; University of Rouen, Rouen, France.
| | - Katia Lehongre
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, Inserm, CNRS, APHP, Hôpital Pitié-Salpêtrière, Paris, France; STIM Platform, CENIR, ICM, Paris, France
| | - Matthieu Faillot
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, Inserm, CNRS, APHP, Hôpital Pitié-Salpêtrière, Paris, France; Neurosurgery Department AP-HP, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Paris, France
| | - Antoine Collomb-Clerc
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, Inserm, CNRS, APHP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Hayat Belaid
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, Inserm, CNRS, APHP, Hôpital Pitié-Salpêtrière, Paris, France; Neurosurgery Department AP-HP, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Paris, France
| | - Brian Lau
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, Inserm, CNRS, APHP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Carine Karachi
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, Inserm, CNRS, APHP, Hôpital Pitié-Salpêtrière, Paris, France; STIM Platform, CENIR, ICM, Paris, France; Neurosurgery Department AP-HP, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Paris, France
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Calvano A, Kleinholdermann U, Heun AS, Bopp MHA, Nimsky C, Timmermann L, Pedrosa DJ. Structural connectivity of low-frequency subthalamic stimulation for improving stride length in Parkinson's disease. Neuroimage Clin 2024; 42:103591. [PMID: 38507954 PMCID: PMC10965492 DOI: 10.1016/j.nicl.2024.103591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 03/07/2024] [Accepted: 03/13/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND A reduction in stride length is considered a key characteristic of gait kinematics in Parkinson's disease (PD) and has been identified as a predictor of falls. Although low-frequency stimulation (LFS) has been suggested as a method to improve gait characteristics, the underlying structural network is not well understood. OBJECTIVE This study aims to investigate the structural correlates of changes in stride length during LFS (85 Hz). METHODS Objective gait performance was retrospectively evaluated in 19 PD patients who underwent deep brain stimulation (DBS) at 85 Hz and 130 Hz. Individual DBS contacts and volumes of activated tissue (VAT) were computed using preoperative magnetic resonance imaging (MRI) and postoperative computed tomography (CT) scans. Structural connectivity profiles to predetermined cortical and mesencephalic areas were estimated using a normative connectome. RESULTS LFS led to a significant improvement in stride length compared to 130 Hz stimulation. The intersection between VAT and the associative subregion of the subthalamic nucleus (STN) was associated with an improvement in stride length and had structural connections to the supplementary motor area, prefrontal cortex, and pedunculopontine nucleus. Conversely, we found that a lack of improvement was linked to stimulation volumes connected to cortico-diencephalic fibers bypassing the STN dorsolaterally. The robustness of the connectivity model was verified through leave-one-patient-out, 5-, and 10-fold cross cross-validation paradigms. CONCLUSION These findings offer new insights into the structural connectivity that underlies gait changes following LFS. Targeting the non-motor subregion of the STN with LFS on an individual level may present a potential therapeutic approach for PD patients with gait disorders.
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Affiliation(s)
- Alexander Calvano
- Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | - Urs Kleinholdermann
- Department of Neurology, Philipps-University Marburg, Marburg, Germany; Center of Mind, Brain and Behaviour, Philipps-University Marburg, Marburg, Germany
| | | | - Miriam H A Bopp
- Center of Mind, Brain and Behaviour, Philipps-University Marburg, Marburg, Germany; Department of Neurosurgery, Philipps-University Marburg, Marburg, Germany
| | - Christopher Nimsky
- Center of Mind, Brain and Behaviour, Philipps-University Marburg, Marburg, Germany; Department of Neurosurgery, Philipps-University Marburg, Marburg, Germany
| | - Lars Timmermann
- Department of Neurology, Philipps-University Marburg, Marburg, Germany; Center of Mind, Brain and Behaviour, Philipps-University Marburg, Marburg, Germany
| | - David J Pedrosa
- Department of Neurology, Philipps-University Marburg, Marburg, Germany; Center of Mind, Brain and Behaviour, Philipps-University Marburg, Marburg, Germany.
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Hong Y, Bao D, Manor B, Zhou J. Characterizing the supraspinal sensorimotor control of walking using MRI-compatible system: a systematic review. J Neuroeng Rehabil 2024; 21:34. [PMID: 38443983 PMCID: PMC10913571 DOI: 10.1186/s12984-024-01323-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 02/09/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND The regulation of gait is critical to many activities of everyday life. When walking, somatosensory information obtained from mechanoreceptors throughout body is delivered to numerous supraspinal networks and used to execute the appropriate motion to meet ever-changing environmental and task demands. Aging and age-related conditions oftentimes alter the supraspinal sensorimotor control of walking, including the responsiveness of the cortical brain regions to the sensorimotor inputs obtained from the peripheral nervous system, resulting in diminished mobility in the older adult population. It is thus important to explicitly characterize such supraspinal sensorimotor elements of walking, providing knowledge informing novel rehabilitative targets. The past efforts majorly relied upon mental imagery or virtual reality to study the supraspinal control of walking. Recent efforts have been made to develop magnetic resonance imaging (MRI)-compatible devices simulating specific somatosensory and/or motor aspects of walking. However, there exists large variance in the design and functionality of these devices, and as such inconsistent functional MRI (fMRI) observations. METHODS We have therefore completed a systematic review to summarize current achievements in the development of these MRI-compatible devices and synthesize available imaging results emanating from studies that have utilized these devices. RESULTS The device design, study protocol and neuroimaging observations of 26 studies using 13 types of devices were extracted. Three of these devices can provide somatosensory stimuli, eight motor stimuli, and two both types of stimuli. Our review demonstrated that using these devices, fMRI data of brain activation can be successfully obtained when participants remain motionless and experience sensorimotor stimulation during fMRI acquisition. The activation in multiple cortical (e.g., primary sensorimotor cortex) and subcortical (e.g., cerebellum) regions has been each linked to these types of walking-related sensorimotor stimuli. CONCLUSION The observations of these publications suggest the promise of implementing these devices to characterize the supraspinal sensorimotor control of walking. Still, the evidence level of these neuroimaging observations was still low due to small sample size and varied study protocols, which thus needs to be confirmed via studies with more rigorous design.
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Affiliation(s)
- Yinglu Hong
- School of Sport Medicine and Physical Therapy, Beijing Sport University, Beijing, China
| | - Dapeng Bao
- China Institute of Sport and Health Science, Beijing Sport University, Beijing, China.
| | - Brad Manor
- Hebrew SeniorLife Hinda and Arthur Marcus Institute for Aging Research, Harvard Medical School, Boston, MA, USA
| | - Junhong Zhou
- Hebrew SeniorLife Hinda and Arthur Marcus Institute for Aging Research, Harvard Medical School, Boston, MA, USA
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Feng T, Zhang L, Wu Y, Tang L, Chen X, Li Y, Shan C. Exploring the Therapeutic Effects and Mechanisms of Transcranial Alternating Current Stimulation on Improving Walking Ability in Stroke Patients via Modulating Cerebellar Gamma Frequency Band-a Narrative Review. CEREBELLUM (LONDON, ENGLAND) 2023:10.1007/s12311-023-01632-3. [PMID: 37962773 DOI: 10.1007/s12311-023-01632-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/01/2023] [Indexed: 11/15/2023]
Abstract
The cerebellum plays an important role in maintaining balance, posture control, muscle tone, and lower limb coordination in healthy individuals and stroke patients. At the same time, the relationship between cerebellum and motor learning has been widely concerned in recent years. Due to the relatively intact structure preservation and high plasticity after supratentorial stroke, non-invasive neuromodulation targeting the cerebellum is increasingly used to treat abnormal gait in stroke patients. The gamma frequency of transcranial alternating current stimulation (tACS) is commonly used to improve motor learning. It is an essential endogenous EEG oscillation in the gamma range during the swing phase, and rhythmic movement changes in the gait cycle. However, the effect of cerebellar tACS in the gamma frequency band on balance and walking after stroke remains unknown and requires further investigation.
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Affiliation(s)
- Tingyi Feng
- Department of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lichao Zhang
- Department of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yuwei Wu
- Department of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lin Tang
- Department of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xixi Chen
- Department of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yuanli Li
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, Shanghai, China
- Department of Rehabilitation, Shanghai Seventh People's Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Chunlei Shan
- Department of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
- Institute of Rehabilitation, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Wu X, Wang Y, Chang J, Zhu K, Zhang S, Li Y, Zuo J, Chen S, Jin W, Yan T, Yang K, Xu P, Song P, Wu Y, Qian Y, Shen C, Yu Y, Dong F. Remodeling of the brain correlates with gait instability in cervical spondylotic myelopathy. Front Neurosci 2023; 17:1087945. [PMID: 36816111 PMCID: PMC9932596 DOI: 10.3389/fnins.2023.1087945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 01/17/2023] [Indexed: 02/05/2023] Open
Abstract
Introduction Cervical spondylotic myelopathy (CSM) is a common form of non-traumatic spinal cord injury (SCI) and usually leads to remodeling of the brain and spinal cord. In CSM with gait instability, the remodeling of the brain and cervical spinal cord is unclear. We attempted to explore the remodeling of these patients' brains and spinal cords, as well as the relationship between the remodeling of the brain and spinal cord and gait instability. Methods According to the CSM patients' gait, we divided patients into two groups: normal gait patients (nPT) and abnormal gait patients (aPT). Voxel-wise z-score transformation amplitude of low-frequency fluctuations (zALFF) and resting-state functional connectivity (rs-FC) were performed for estimating brain changes. Cross-sectional area (CSA) and fractional anisotropy (FA) of the spinal cord were computed by Spinal cord toolbox. Correlations of these measures and the modified Japanese Orthopedic Association (mJOA) score were analyzed. Results We found that the zALFF of caudate nucleus in aPT was higher than that in healthy controls (HC) and lower than that in nPT. The zALFF of the right postcentral gyrus and paracentral lobule in HC was higher than those of aPT and nPT. Compared with the nPT, the aPT showed increased functional connectivity between the caudate nucleus and left angular gyrus, bilateral precuneus and bilateral posterior cingulate cortex (PCC), which constitute a vital section of the default mode network (DMN). No significantly different FA values or CSA of spinal tracts at the C2 level were observed between the HC, nPT and aPT groups. In CSM, the right paracentral lobule's zALFF was negatively correlated with the FA value of fasciculus gracilis (FCG), and the right caudate zALFF was positively correlated with the FA value of the fasciculus cuneatus (FCC). The results showed that the functional connectivity between the right caudate nucleus and DMN was negatively correlated with the CSA of the lateral corticospinal tract (CST). Discussion The activation of the caudate nucleus and the strengthening functional connectivity between the caudate nucleus and DMN were associated with gait instability in CSM patients. Correlations between spinal cord and brain function might be related to the clinical symptoms in CSM.
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Affiliation(s)
- Xianyong Wu
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, China,Department of Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Ying Wang
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jianchao Chang
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, China,Department of Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Kun Zhu
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, China,Department of Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Siya Zhang
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, China,Department of Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China,School of Basic Medical Sciences, Anhui Medical University, Hefei, China
| | - Yan Li
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, China,Department of Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Junxun Zuo
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, China,Department of Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Senlin Chen
- Department of Orthopedics, Dongcheng Branch of The First Affiliated Hospital of Anhui Medical University (Feidong People’s Hospital), Hefei, China
| | - Weiming Jin
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, China,Department of Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Tingfei Yan
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, China,Department of Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Kun Yang
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, China,Department of Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Peng Xu
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, China,Department of Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Peiwen Song
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, China,Department of Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yuanyuan Wu
- Department of Medical Imaging, The First Affiliated Hospital of Anhui Medical University, Hefei, China,Yuanyuan Wu,
| | - Yinfeng Qian
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Cailiang Shen
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, China,Department of Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yongqiang Yu
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Fulong Dong
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, China,*Correspondence: Fulong Dong,
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Grosprêtre S, Eon P, Marcel-Millet P. Virtual reality does not fool the brain only: spinal excitability changes during virtually simulated falling. J Neurophysiol 2023; 129:368-379. [PMID: 36515975 DOI: 10.1152/jn.00383.2022] [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: 12/15/2022] Open
Abstract
Virtual reality (VR) is known to induce substantial activation of brain's motor regions. It remains unclear to what extent virtual reality can trigger the sensorimotor system, and more particularly, whether it can affect lower nervous levels. In this study, we aimed to assess whether VR simulation of challenging and stressful postural situations (Richie's plank experience) could interfere with spinal excitability of postural muscles in 15 healthy young participants. The H-reflex of the triceps surae muscles was elicited with electrical nerve stimulation while participants were standing and wearing a VR headset. Participants went through several conditions, during which stimulations were evoked: standing still (noVR), standing in VR on the ground (groundVR), standing on the edge of a building (plankVR), and falling from the building (fallingVR). Myoelectrical activity of the triceps surae muscles was measured throughout the experiment. Leg and head movements were also measured by means of accelerometers to account for body oscillations. First, no differences in head rotations and myoelectrical activity were to be noted between conditions. Second, triceps H-reflex (HMAX/MMAX) was not affected from noVR to groundVR and plankVR. The most significant finding was a drastic decrease in H-reflex during falling (-47 ± 26.9% between noVR and fallingVR, P = 0.015). It is suggested that experiencing a postural threat in VR efficiently modulates spinal excitability, despite remaining in a quiet standing posture. This study suggests that simulated falling mimics the neural adjustments observed during actual postural challenge tasks.NEW & NOTEWORTHY The present study showed a modulation of spinal excitability induced by virtual reality (VR). In the standing position, soleus H-reflex was downmodulated during a simulated falling, in the absence of apparent changes in body oscillations. Since the same behavior is usually observed during real falling, it was suggested that the visual cues provided by VR were sufficiently strong to lead the neuromuscular system to mimic the actual modulation.
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Affiliation(s)
- Sidney Grosprêtre
- Laboratory Culture Sport Health and Society (C3S-UR 4660), Sport and Performance Department, University of Franche-Comté, Besançon, France
| | - Pauline Eon
- Laboratory Culture Sport Health and Society (C3S-UR 4660), Sport and Performance Department, University of Franche-Comté, Besançon, France
| | - Philémon Marcel-Millet
- Laboratory Culture Sport Health and Society (C3S-UR 4660), Sport and Performance Department, University of Franche-Comté, Besançon, France
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Moore J, Stuart S, McMeekin P, Walker R, Celik Y, Pointon M, Godfrey A. Enhancing Free-Living Fall Risk Assessment: Contextualizing Mobility Based IMU Data. SENSORS (BASEL, SWITZERLAND) 2023; 23:s23020891. [PMID: 36679685 PMCID: PMC9866998 DOI: 10.3390/s23020891] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/06/2023] [Accepted: 01/10/2023] [Indexed: 05/14/2023]
Abstract
Fall risk assessment needs contemporary approaches based on habitual data. Currently, inertial measurement unit (IMU)-based wearables are used to inform free-living spatio-temporal gait characteristics to inform mobility assessment. Typically, a fluctuation of those characteristics will infer an increased fall risk. However, current approaches with IMUs alone remain limited, as there are no contextual data to comprehensively determine if underlying mechanistic (intrinsic) or environmental (extrinsic) factors impact mobility and, therefore, fall risk. Here, a case study is used to explore and discuss how contemporary video-based wearables could be used to supplement arising mobility-based IMU gait data to better inform habitual fall risk assessment. A single stroke survivor was recruited, and he conducted a series of mobility tasks in a lab and beyond while wearing video-based glasses and a single IMU. The latter generated topical gait characteristics that were discussed according to current research practices. Although current IMU-based approaches are beginning to provide habitual data, they remain limited. Given the plethora of extrinsic factors that may influence mobility-based gait, there is a need to corroborate IMUs with video data to comprehensively inform fall risk assessment. Use of artificial intelligence (AI)-based computer vision approaches could drastically aid the processing of video data in a timely and ethical manner. Many off-the-shelf AI tools exist to aid this current need and provide a means to automate contextual analysis to better inform mobility from IMU gait data for an individualized and contemporary approach to habitual fall risk assessment.
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Affiliation(s)
- Jason Moore
- Department of Computer and Information Sciences, Northumbria University, Newcastle upon Tyne NE1 8ST, UK
| | - Samuel Stuart
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne NE1 8ST, UK
- Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne NE1 8ST, UK
| | - Peter McMeekin
- Department of Nursing and Midwifery, Northumbria University, Newcastle upon Tyne NE1 8ST, UK
| | - Richard Walker
- Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne NE1 8ST, UK
| | - Yunus Celik
- Department of Computer and Information Sciences, Northumbria University, Newcastle upon Tyne NE1 8ST, UK
| | - Matthew Pointon
- Department of Computer and Information Sciences, Northumbria University, Newcastle upon Tyne NE1 8ST, UK
| | - Alan Godfrey
- Department of Computer and Information Sciences, Northumbria University, Newcastle upon Tyne NE1 8ST, UK
- Correspondence:
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Temiz G, Santin MDN, Olivier C, Collomb-Clerc A, Fernandez-Vidal S, Hainque E, Bardinet E, Lau B, François C, Karachi C, Welter ML. Freezing of gait depends on cortico-subthalamic network recruitment following STN-DBS in PD patients. Parkinsonism Relat Disord 2022; 104:49-57. [PMID: 36242900 DOI: 10.1016/j.parkreldis.2022.10.002] [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] [Received: 06/13/2022] [Revised: 09/29/2022] [Accepted: 10/02/2022] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Subthalamic deep-brain-stimulation (STN-DBS) is an effective means to treat Parkinson's disease (PD) symptoms. Its benefit on gait disorders is variable, with freezing of gait (FOG) worsening in about 30% of cases. Here, we investigate the clinical and anatomical features that could explain post-operative FOG. METHODS Gait and balance disorders were assessed in 19 patients, before and after STN-DBS using clinical scales and gait recordings. The location of active stimulation contacts were evaluated individually and the volumes of activated tissue (VAT) modelled for each hemisphere. We used a whole brain tractography template constructed from another PD cohort to assess the connectivity of each VAT within the 39 Brodmann cortical areas (BA) to search for correlations between postoperative PD disability and cortico-subthalamic connectivity. RESULTS STN-DBS induced a 100% improvement to a 166% worsening in gait disorders, with a mean FOG decrease of 36%. We found two large cortical clusters for VAT connectivity: one "prefrontal", mainly connected with BA 8,9,10,11 and 32, and one "sensorimotor", mainly connected with BA 1-2-3,4 and 6. After surgery, FOG severity positively correlated with the right prefrontal VAT connectivity, and negatively with the right sensorimotor VAT connectivity. The right prefrontal VAT connectivity also tended to be positively correlated with the UPDRS-III score, and negatively with step length. The MDRS score positively correlated with the right sensorimotor VAT connectivity. CONCLUSION Recruiting right sensorimotor and avoiding right prefrontal cortico-subthalamic fibres with STN-DBS could explain reduced post-operative FOG, since gait is a complex locomotor program that necessitates accurate cognitive control.
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Affiliation(s)
- Gizem Temiz
- Inserm 1127, Sorbonne Université, UPMC Univ Paris 06, UMRS 1127, CNRS, UMR 7225, Institut Du Cerveau et de la Moelle Epinière, F-75013, Paris, France
| | - Marie des Neiges Santin
- Inserm 1127, Sorbonne Université, UPMC Univ Paris 06, UMRS 1127, CNRS, UMR 7225, Institut Du Cerveau et de la Moelle Epinière, F-75013, Paris, France
| | - Claire Olivier
- Inserm 1127, Sorbonne Université, UPMC Univ Paris 06, UMRS 1127, CNRS, UMR 7225, Institut Du Cerveau et de la Moelle Epinière, F-75013, Paris, France; PANAM core Facility, Paris Brain Institute, Paris, France
| | - Antoine Collomb-Clerc
- Inserm 1127, Sorbonne Université, UPMC Univ Paris 06, UMRS 1127, CNRS, UMR 7225, Institut Du Cerveau et de la Moelle Epinière, F-75013, Paris, France
| | - Sara Fernandez-Vidal
- Inserm 1127, Sorbonne Université, UPMC Univ Paris 06, UMRS 1127, CNRS, UMR 7225, Institut Du Cerveau et de la Moelle Epinière, F-75013, Paris, France
| | - Elodie Hainque
- Inserm 1127, Sorbonne Université, UPMC Univ Paris 06, UMRS 1127, CNRS, UMR 7225, Institut Du Cerveau et de la Moelle Epinière, F-75013, Paris, France
| | - Eric Bardinet
- Inserm 1127, Sorbonne Université, UPMC Univ Paris 06, UMRS 1127, CNRS, UMR 7225, Institut Du Cerveau et de la Moelle Epinière, F-75013, Paris, France
| | - Brian Lau
- Inserm 1127, Sorbonne Université, UPMC Univ Paris 06, UMRS 1127, CNRS, UMR 7225, Institut Du Cerveau et de la Moelle Epinière, F-75013, Paris, France
| | - Chantal François
- Inserm 1127, Sorbonne Université, UPMC Univ Paris 06, UMRS 1127, CNRS, UMR 7225, Institut Du Cerveau et de la Moelle Epinière, F-75013, Paris, France
| | - Carine Karachi
- Inserm 1127, Sorbonne Université, UPMC Univ Paris 06, UMRS 1127, CNRS, UMR 7225, Institut Du Cerveau et de la Moelle Epinière, F-75013, Paris, France; Neurosurgery Department, AP-HP, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, F-75013, Paris, France
| | - Marie-Laure Welter
- Inserm 1127, Sorbonne Université, UPMC Univ Paris 06, UMRS 1127, CNRS, UMR 7225, Institut Du Cerveau et de la Moelle Epinière, F-75013, Paris, France; PANAM core Facility, Paris Brain Institute, Paris, France; Neurophysiology Department, Rouen University Hospital, CHU Rouen, F-76000, Rouen, France.
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Yang H, Liu WV, Wang S, Yang W, Liu C, Wen Z, Hu L, Guo J, Fan G, Luo X, Zha Y. Freezing of Gait in Multiple System Atrophy. Front Aging Neurosci 2022; 14:833287. [PMID: 35462702 PMCID: PMC9024348 DOI: 10.3389/fnagi.2022.833287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 03/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background and PurposeFreezing of gait (FOG) is a common gait disturbance phenomenon in multiple system atrophy (MSA) patients. The current investigation assessed the incidence FOG in a cross-sectional clinical study, and clinical correlations associated with it.MethodsNinety-nine MSA patients from three hospitals in China were consecutively enrolled in the study. Eight patients were subsequently excluded from the analysis due to incomplete information. The prevalence of FOG symptoms in the MSA cohort was determined, and clinical manifestations in MSA patients with and without FOG were assessed.ResultsOf 91 MSA patients, 60 (65.93%) exhibited FOG. The incidence of FOG increased with disease duration and motor severity and was correlated with modified Hoehn and Yahr (H-Y) stages [odds ratio (OR), 0.54; 95% confidence interval (CI), 0.33–3.92], longer disease duration (OR, 0.54, 95% CI, 0.37–0.78), higher Unified Multiple System Atrophy Rating Scale (UMSARS) score (OR, 0.96, 95% CI, 0.93–0.99), MSA-cerebellum subtype (OR, 2.99, 95% CI, 1.22–7.33), levodopa-equivalent dose (LDED) (OR, 0.998, 95% CI, 0.997–1.00), and higher Scale for the Assessment and Rating of Ataxia (SARA) score (OR, 0.80, 95% CI, 0.72–0.89) (logistic regression). Motor dysfunction was significantly positively associated with lower quality of life scores (p < 0.01).ConclusionFOG is a common symptom in MSA patients and it is correlated with poor quality of life, disease progression and severity, levodopa-equivalent dose, and cerebellum impairment.
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Affiliation(s)
- Huaguang Yang
- Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, China
| | | | - Shanshan Wang
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Wenbin Yang
- Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Changsheng Liu
- Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zhi Wen
- Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Lanhua Hu
- Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jinxia Guo
- MR Research, GE Healthcare, Beijing, China
| | - Guoguang Fan
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Xiaoguang Luo
- Department of Neurology, The First Affiliated Hospital of South University of Science and Technology, The Second Clinical Medical College of Jinan University, Shenzhen People’s Hospital, Shenzhen, China
- *Correspondence: Xiaoguang Luo,
| | - Yunfei Zha
- Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, China
- Yunfei Zha,
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Bourilhon J, Olivier C, You H, Collomb-Clerc A, Grabli D, Belaid H, Mullie Y, François C, Czernecki V, Lau B, Pérez-García F, Bardinet E, Fernandez-Vidal S, Karachi C, Welter ML. Pedunculopontine and Cuneiform Nuclei Deep Brain Stimulation for Severe Gait and Balance Disorders in Parkinson's Disease: Interim Results from a Randomised Double-Blind Clinical Trial. JOURNAL OF PARKINSONS DISEASE 2021; 12:639-653. [PMID: 34744048 DOI: 10.3233/jpd-212793] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Dopa-resistant freezing of gait (FOG) and falls represent the dominant motor disabilities in advanced Parkinson's disease (PD). OBJECTIVE We investigate the effects of deep brain stimulation (DBS) of the mesencephalic locomotor region (MLR), comprised of the pedunculopontine (PPN) and cuneiform (CuN) nuclei, for treating gait and balance disorders, in a randomized double-blind cross-over trial. METHODS Six PD patients with dopa-resistant FOG and/or falls were operated for MLR-DBS. Patients received three DBS conditions, PPN, CuN, or sham, in a randomized order for 2-months each, followed by an open-label phase. The primary outcome was the change in anteroposterior anticipatory-postural-adjustments (APAs) during gait initiation on a force platformResults:The anteroposterior APAs were not significantly different between the DBS conditions (median displacement [1st-3rd quartile] of 3.07 [3.12-4.62] cm with sham-DBS, 1.95 [2.29-3.85] cm with PPN-DBS and 2.78 [1.66-4.04] cm with CuN-DBS; p = 0.25). Step length and velocity were significantly higher with CuN-DBS vs. both sham-DBS and PPN-DBS. Conversely, step length and velocity were lower with PPN-DBS vs. sham-DBS, with greater double stance and gait initiation durations. One year after surgery, step length was significantly lower with PPN-DBS vs. inclusion. We did not find any significant change in clinical scales between DBS conditions or one year after surgery. CONCLUSION Two months of PPN-DBS or CuN-DBS does not effectively improve clinically dopa-resistant gait and balance disorders in PD patients.
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Affiliation(s)
- Julie Bourilhon
- Department of Neurophysiology, Rouen UniversityHospital and University of Rouen, France.,Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France PANAM platform, Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France
| | - Claire Olivier
- Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France PANAM platform, Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France.,PANAM platform, Institut du Cerveau et de la Moelle É14 pinière (ICM), Paris, France
| | - Hana You
- Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France PANAM platform, Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France.,Clinical Investigation Center, Pitié-Salpêtrière, Charles Foix University Hospital, Assistance Publique-Hôpitaux de Paris, Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France
| | - Antoine Collomb-Clerc
- Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France PANAM platform, Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France
| | - David Grabli
- Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France PANAM platform, Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France.,Fédération des Maladies du Système Nerveux, Pitié-Salpêtrière, Charles Foix University Hospital, Assistance Publique-Hôpitaux de Paris Paris, Paris, France
| | - Hayat Belaid
- Department of Neurosurgery, Pitié-Salpêtrière, Charles Foix University Hospital, Assistance Publique-Hôpitaux Paris, Paris, France
| | - Yannick Mullie
- Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France PANAM platform, Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France
| | - Chantal François
- Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France PANAM platform, Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France
| | - Virginie Czernecki
- Fédération des Maladies du Système Nerveux, Pitié-Salpêtrière, Charles Foix University Hospital, Assistance Publique-Hôpitaux de Paris Paris, Paris, France
| | - Brian Lau
- Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France PANAM platform, Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France
| | - Fernando Pérez-García
- Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France PANAM platform, Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France.,CENIR Platform, Institut du Cerveau et de la Moelle É22 pinière (ICM), Paris, France
| | - Eric Bardinet
- Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France PANAM platform, Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France.,CENIR Platform, Institut du Cerveau et de la Moelle É22 pinière (ICM), Paris, France
| | - Sara Fernandez-Vidal
- Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France PANAM platform, Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France.,STIM Platform, Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France
| | - Carine Karachi
- Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France PANAM platform, Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France.,Department of Neurosurgery, Pitié-Salpêtrière, Charles Foix University Hospital, Assistance Publique-Hôpitaux Paris, Paris, France
| | - Marie-Laure Welter
- Department of Neurophysiology, Rouen UniversityHospital and University of Rouen, France.,Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France PANAM platform, Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France
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