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Freeze of Gait in Parkinson's disease

Moran Gilat, Ana Lígia Silva de Lima, Bastiaan R Bloem, James M Shine, Jorik Nonnekes, Simon J G Lewis
Freezing of gait is a devastating symptom of Parkinson's disease and other forms of parkinsonism. It poses a major burden on both patients and their families, as freezing often leads to falls, fall-related injuries and a loss of independence. Treating freezing of gait is difficult for a variety of reasons: it has a paroxysmal and unpredictable nature; a multifaceted pathophysiology, with an interplay between motor elements (disturbed stepping mechanisms) and non-motor elements (cognitive decline, anxiety); and a complex (and likely heterogeneous) underlying neural substrate, involving multiple failing neural networks...
March 12, 2018: Parkinsonism & related Disorders
Ruwei Ou, Qianqian Wei, Bei Cao, Wei Song, Yanbing Hou, Hui Liu, Xiaoqin Yuan, Bi Zhao, Ying Wu, Huifang Shang
Objective: To explore the clinical predictors of freezing of gait (FOG) in Chinese patients with Parkinson's disease (PD). Methods: This study included 225 patients with PD who completed a three-year follow-up visit. The end-point was the presence of FOG (freezers), which was assessed during the follow-up visit. Group comparisons were conducted, followed by a further forward binary logistic regression analysis. Results: Eighty-five patients with PD (38%) had developed FOG at the end of study...
March 2018: Brain and Behavior
Jiayue Cai, Soojin Lee, Fang Ba, Saurabh Garg, Laura J Kim, Aiping Liu, Diana Kim, Z Jane Wang, Martin J McKeown
Falls and balance difficulties remain a major source of morbidity in Parkinson's Disease (PD) and are stubbornly resistant to therapeutic interventions. The mechanisms of gait impairment in PD are incompletely understood but may involve changes in the Pedunculopontine Nucleus (PPN) and its associated connections. We utilized fMRI to explore the modulation of PPN connectivity by Galvanic Vestibular Stimulation (GVS) in healthy controls ( n = 12) and PD subjects even without overt evidence of Freezing of Gait (FOG) while on medication ( n = 23)...
2018: Frontiers in Neuroscience
Tao-Mian Mi, Shan-Shan Mei, Pei-Peng Liang, Lin-Lin Gao, Kun-Cheng Li, Tao Wu, Piu Chan
A correction to this article has been published and is linked from the HTML and PDF versions of this paper. The error has not been fixed in the paper.
March 14, 2018: Scientific Reports
Ryul Kim, Joongyub Lee, Yoon Kim, Aryun Kim, Mihee Jang, Han-Joon Kim, Beomseok Jeon, Un Jung Kang, Stanley Fahn
INTRODUCTION: The current study was designed to determine whether the degree of presynaptic striatal dopamine depletion can predict the later development of freezing of gait (FOG) in Parkinson's disease (PD). METHODS: This retrospective cohort study included 390 de novo patients with PD without FOG at baseline. The participants were divided into tertiles according to the baseline dopamine transporter (DAT) uptake of each striatal subregion, and the cumulative risk of FOG was compared using the Kaplan-Meier method...
February 28, 2018: Parkinsonism & related Disorders
A M Ardi Handojoseno, Ganesh R Naik, Moran Gilat, James M Shine, Tuan N Nguyen, Quynh T Ly, Simon J G Lewis, Hung T Nguyen
Freezing of gait (FOG) is an episodic gait disturbance affecting initiation and continuation of locomotion in many Parkinson's disease (PD) patients, causing falls and a poor quality of life. FOG can be experienced on turning and start hesitation, passing through doorways or crowded areas dual tasking, and in stressful situations. Electroencephalography (EEG) offers an innovative technique that may be able to effectively foresee an impending FOG. From data of 16 PD patients, using directed transfer function (DTF) and independent component analysis (ICA) as data pre-processing, and an optimal Bayesian neural network as a predictor of a transition of 5 seconds before the impending FOG occurs in 11 in-group PD patients, we achieved sensitivity and specificity of 85...
2018: Studies in Health Technology and Informatics
Chuyi Huang, Heling Chu, Yan Zhang, Xiaoping Wang
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...
2018: Frontiers in Neuroscience
Christian Schlenstedt, Martina Mancini, Jay Nutt, Amie P Hiller, Walter Maetzler, Günther Deuschl, Fay Horak
Introduction: This study aims at investigating whether impaired anticipatory postural adjustments (APA) during gait initiation contribute to the occurrence of freezing of gait (FOG) or whether altered APAs compensate for FOG in Parkinson's disease (PD). Methods: Gait initiation after 30 s quiet stance was analyzed without and with a cognitive dual task (DT) in 33 PD subjects with FOG (PD+FOG), 30 PD subjects without FOG (PD-FOG), and 32 healthy controls (HC). APAs were characterized with inertial sensors and muscle activity of the tensor fasciae latae (TFL), gastrocnemius, and tibialis anterior was captured with electromyography recordings...
2018: Frontiers in Aging Neuroscience
Hiroshi Kataoka, Noriyuki Tanaka, Takao Kiriyama, Nobuyuki Eura, Masanori Ikeda, Tesseki Izumi, Yoshiko Furiya, Kazuma Sugie, Satoshi Ueno
BACKGROUND: Freezing of gait (FOG) has been linked to increased numbers of steps taken while walking. We tested the hypothesis that an increased number of steps associated with FOG might predict the exacerbation of the severity of Parkinson's disease (PD). METHODS: We prospectively studied 26 patients. Clinical assessments were performed and balance was evaluated in 30 patients with Hoehn-Yahr stage III PD 6 years previously. Gait parameters were analyzed with the use of an originally designed, suddenly narrowed path...
February 22, 2018: European Neurology
Kaylena A Ehgoetz Martens, Julie M Hall, Matthew J Georgiades, Moran Gilat, Courtney C Walton, Elie Matar, Simon J G Lewis, James M Shine
Freezing of gait is a complex, heterogeneous, and highly variable phenomenon whose pathophysiology and neural signature remains enigmatic. Evidence suggests that freezing is associated with impairments across cognitive, motor and affective domains; however, most research to date has focused on investigating one axis of freezing of gait in isolation. This has led to inconsistent findings and a range of different pathophysiological models of freezing of gait, due in large part to the tendency for studies to investigate freezing of gait as a homogeneous entity...
February 9, 2018: Brain: a Journal of Neurology
Olivia Samotus, Andrew Parrent, Mandar Jog
BACKGROUND: Benefits of dopaminergic therapy and deep brain stimulation are limited and unpredictable for axial symptoms in Parkinson's disease. Dorsal spinal cord stimulation may be a new therapeutic approach. The objective of this study was to investigate the therapeutic effect of spinal cord stimulation on gait including freezing of gait in advanced PD patients. METHODS: Five male PD participants with significant gait disturbances and freezing of gait underwent midthoracic spinal cord stimulation...
February 14, 2018: Movement Disorders: Official Journal of the Movement Disorder Society
Moria Dagan, Talia Herman, Rachel Harrison, Junhong Zhou, Nir Giladi, Giulio Ruffini, Brad Manor, Jeffrey M Hausdorff
BACKGROUND: Recent findings suggest that transcranial direct current stimulation of the primary motor cortex may ameliorate freezing of gait. However, the effects of multitarget simultaneous stimulation of motor and cognitive networks are mostly unknown. The objective of this study was to evaluate the effects of multitarget transcranial direct current stimulation of the primary motor cortex and left dorsolateral prefrontal cortex on freezing of gait and related outcomes. METHODS: Twenty patients with Parkinson's disease and freezing of gait received 20 minutes of transcranial direct current stimulation on 3 separate visits...
February 13, 2018: Movement Disorders: Official Journal of the Movement Disorder Society
Martina Mancini, Aner Weiss, Talia Herman, Jeffrey M Hausdorff
Difficulty in turning while walking is common among patients with Parkinson's disease (PD). This difficulty often leads to significant disability, falls, and loss of function; moreover, turning is a common trigger for freezing of gait (FoG). We hypothesized that the quantity and quality of turning mobility while walking during daily life would be different among subjects with PD with and without FoG. Here, we investigated, for the first time, the turning quality during daily life as it relates to FoG in people with PD using a single inertial sensor...
2018: Frontiers in Neurology
Susanna Mezzarobba, Michele Grassi, Roberto Valentini, Paolo Bernardis
INTRODUCTION: The intricate linkage between Freezing of Gait (FoG) and postural control in Parkinson's disease (PD) is unclear. We analyzed the impact of FoG on dynamic postural control. METHODS: 24 PD patients, 12 with (PD + FoG), 12 without FoG (PD-FoG), and 12 healthy controls, were assessed in ON state. Mobility and postural control were measured with clinical scales (UPDRS III, BBS, MPAS) and with kinematic and kinetic analysis during three tasks, characterized by levels of increasing difficulty to plan sequential movement of postural control: walk (W), gait initiation (GI) and sit-to-walk (STW)...
February 2, 2018: Gait & Posture
Minji Son, Sang-Myung Cheon, Changhong Youm, Youkyung Kim, Jae Woo Kim
Freezing of gait (FOG) is a major risk factor for falls and fall-related injuries in patients with Parkinson's disease (PD). The characteristics of gait in PD patients with FOG have been studied but remain controversial. To investigate gait characteristics of FOG in PD, this study analyzed the forward and backward walking of patients with PD. Twenty-six patients with PD were recruited [age: 71.0 ± 6.2 years, Hoehn and Yahr stage: 2-3 (median 2.5)]. Based on responses to the New Freezing of Gait Questionnaire, we classified patients into either the "freezer" or "non-freezer" group...
February 1, 2018: Gait & Posture
Moran Gilat, Kaylena A Ehgoetz Martens, Oscar Miranda-Domínguez, Ishu Arpan, James M Shine, Martina Mancini, Damien A Fair, Simon J G Lewis, Fay B Horak
Freezing of gait (FOG) is a poorly understood symptom affecting many patients with Parkinson's disease (PD). Despite growing evidence of a behavioral link between anxiety, attention and FOG in PD, no research to date has investigated the neural mechanisms that might explain this relationship. The present study therefore examined resting-state MRI functional connectivity between the amygdala, striatum and frontoparietal attentional control network in PD patients with (freezers: n = 19) and without FOG (non-freezers: n = 21) in the dopaminergic 'off' state...
January 31, 2018: Neuroscience
Maurizio Zibetti, Serena Angrisano, Francesca Dematteis, Carlo Alberto Artusi, Alberto Romagnolo, Aristide Merola, Leonardo Lopiano
OBJECTIVE: To determine the impact of levodopa-carbidopa intestinal gel (LCIG) infusion on different subtypes of freezing of gait (FoG) classified according to levodopa responsiveness in advanced Parkinson disease (PD) patients. METHODS: We retrospectively assessed the presence and severity of FoG in 32 advanced PD patients based on the Unified PD Rating Scale (UPDRS) item 14 score. Different FoG subtypes were inferred from the score variation with oral dopaminergic medications...
February 15, 2018: Journal of the Neurological Sciences
Giovanna Lagravinese, Elisa Pelosin, Gaia Bonassi, Federico Carbone, Giovanni Abbruzzese, Laura Avanzino
BACKGROUND: Freezing of gait is a symptom that affects more than 50% of Parkinson's disease (PD) patients and increasing evidence suggests that nonmotor systems (i.e., limbic system) are involved in its underlying mechanisms. OBJECTIVE: The objective of this study was to investigate whether gait initiation characteristics are influenced by emotional stimuli in patients with PD, with or without freezing of gait. METHODS: A total of 44 participants, divided into 3 groups (15 PD patients with and 15 PD patients without freezing of gait and 14 controls), stood on a sensorized mat and were asked to take a step forward in response to a pleasant image and a step backward in response to an unpleasant one (congruent task, low cognitive load) or to take a step backward in response to a pleasant image and a step forward in response to an unpleasant one (incongruent task, high cognitive load)...
February 2, 2018: Movement Disorders: Official Journal of the Movement Disorder Society
Qian Sun, Tian Wang, Tian-Fang Jiang, Pei Huang, Ying Wang, Qin Xiao, Jun Liu, Sheng-Di Chen
Background: Parkinson's disease (PD) patients with 10 years or more survival (PD-10) are not well characterized. The aim of this study was to evaluate the main issues facing PD-10 patients and identify factors that independently contributed to quality of life (QoL). Methods: A group of 121 PD-10 patients recruited from outpatient clinics participated in this cross-sectional study. Data on demographic and clinical factors were collected. Multiple linear regression analyses were conducted to identify determinants of poor QoL...
February 2018: Aging and Disease
P J Garcia-Ruiz, C E Feliz-Feliz, T Maycas-Cepeda, J Del Val-Fernandez
INTRODUCTION: Reduced facial expression or amimia is one of the most typical characteristics of Parkinson's disease (PD). Despite being described in classic texts, its significance, physiopathology and correlation with motor and non-motor symptoms is largely unknown. PATIENTS AND METHODS: We have studied facial bradykinesia in a group of 84 de novo PD patients prospectively evaluated for five years. We also studied the relationship of facial bradykinesia with depression in a subgroup of 30 patients...
January 16, 2018: Revista de Neurologia
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