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Marquez JS, Hasan SMS, Siddiquee MR, Luca CC, Mishra VR, Mari Z, Bai O. Neural Correlates of Freezing of Gait in Parkinson's Disease: An Electrophysiology Mini-Review. Front Neurol 2020; 11:571086. [PMID: 33240199 PMCID: PMC7683766 DOI: 10.3389/fneur.2020.571086] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/23/2020] [Indexed: 12/13/2022] Open
Abstract
Freezing of gait (FoG) is a disabling symptom characterized as a brief inability to step or by short steps, which occurs when initiating gait or while turning, affecting over half the population with advanced Parkinson's disease (PD). Several non-competing hypotheses have been proposed to explain the pathophysiology and mechanism behind FoG. Yet, due to the complexity of FoG and the lack of a complete understanding of its mechanism, no clear consensus has been reached on the best treatment options. Moreover, most studies that aim to explore neural biomarkers of FoG have been limited to semi-static or imagined paradigms. One of the biggest unmet needs in the field is the identification of reliable biomarkers that can be construed from real walking scenarios to guide better treatments and validate medical and therapeutic interventions. Advances in neural electrophysiology exploration, including EEG and DBS, will allow for pathophysiology research on more real-to-life scenarios for better FoG biomarker identification and validation. The major aim of this review is to highlight the most up-to-date studies that explain the mechanisms underlying FoG through electrophysiology explorations. The latest methodological approaches used in the neurophysiological study of FoG are summarized, and potential future research directions are discussed.
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Affiliation(s)
- J. Sebastian Marquez
- Department of Electrical and Computer Engineering, Florida International University, Miami, FL, United States
| | - S. M. Shafiul Hasan
- Department of Electrical and Computer Engineering, Florida International University, Miami, FL, United States
| | - Masudur R. Siddiquee
- Department of Electrical and Computer Engineering, Florida International University, Miami, FL, United States
| | - Corneliu C. Luca
- Department of Neurology, University of Miami Hospital, Miami, FL, United States
| | - Virendra R. Mishra
- Lou Ruvo Center for Brain Health, Cleveland Clinic, Las Vegas, NV, United States
| | - Zoltan Mari
- Lou Ruvo Center for Brain Health, Cleveland Clinic, Las Vegas, NV, United States
| | - Ou Bai
- Department of Electrical and Computer Engineering, Florida International University, Miami, FL, United States
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Storzer L, Butz M, Hirschmann J, Abbasi O, Gratkowski M, Saupe D, Vesper J, Dalal SS, Schnitzler A. Bicycling suppresses abnormal beta synchrony in the Parkinsonian basal ganglia. Ann Neurol 2017; 82:592-601. [PMID: 28892573 DOI: 10.1002/ana.25047] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 03/23/2017] [Accepted: 09/04/2017] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Freezing of gait is a poorly understood symptom of Parkinson disease, and can severely disrupt the locomotion of affected patients. However, bicycling ability remains surprisingly unaffected in most patients suffering from freezing, suggesting functional differences in the motor network. The purpose of this study was to characterize and contrast the oscillatory dynamics underlying bicycling and walking in the basal ganglia. METHODS We present the first local field potential recordings directly comparing bicycling and walking in Parkinson disease patients with electrodes implanted in the subthalamic nuclei for deep brain stimulation. Low (13-22Hz) and high (23-35Hz) beta power changes were analyzed in 22 subthalamic nuclei from 13 Parkinson disease patients (57.5 ± 5.9 years old, 4 female). The study group consisted of 5 patients with and 8 patients without freezing of gait. RESULTS In patients without freezing of gait, both bicycling and walking led to a suppression of subthalamic beta power (13-35Hz), and this suppression was stronger for bicycling. Freezers showed a similar pattern in general. Superimposed on this pattern, however, we observed a movement-induced, narrowband power increase around 18Hz, which was evident even in the absence of freezing. INTERPRETATION These results indicate that bicycling facilitates overall suppression of beta power. Furthermore, movement leads to exaggerated synchronization in the low beta band specifically within the basal ganglia of patients susceptible to freezing. Abnormal ∼18Hz oscillations are implicated in the pathophysiology of freezing of gait, and suppressing them may form a key strategy in developing potential therapies. Ann Neurol 2017;82:592-601.
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Affiliation(s)
- Lena Storzer
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Markus Butz
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Jan Hirschmann
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,Donders Institute for Brain, Cognition, and Behavior, Radboud University, Nijmegen, the Netherlands
| | - Omid Abbasi
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,Department of Medical Engineering, Ruhr-University Bochum, Bochum, Germany
| | - Maciej Gratkowski
- Department of Computer and Information Science, University of Konstanz, Konstanz, Germany
| | - Dietmar Saupe
- Department of Computer and Information Science, University of Konstanz, Konstanz, Germany
| | - Jan Vesper
- Department of Functional Neurosurgery and Stereotaxy, Medical Faculty, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Sarang S Dalal
- Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark.,Zukunftskolleg and Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Alfons Schnitzler
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,Center for Movement Disorders and Neuromodulation, University Hospital Düsseldorf, Düsseldorf, Germany
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