Gait ataxia in humans: vestibular and cerebellar control of dynamic stability

Abstract

During human locomotion, vestibular feedback control is fundamental for maintaining dynamic stability and adapting the gait pattern to external circumstances. Within the supraspinal locomotor network, the cerebellum represents the key site for the integration of vestibular feedback information. The cerebellum is further important for the fine-tuning and coordination of limb movements during walking. The aim of this review article is to highlight the shared structural and functional sensorimotor principles in vestibular and cerebellar locomotion control. Vestibular feedback for the maintenance of dynamic stability is integrated into the locomotor pattern via midline, caudal cerebellar structures (vermis, flocculonodular lobe). Hemispheric regions of the cerebellum facilitate feed-forward control of multi-joint coordination and higher locomotor functions. Characteristic features of the gait disorder in patients with vestibular deficits or cerebellar ataxia are increased levels of spatiotemporal gait variability in the fore-aft and the medio-lateral gait dimension. In the fore-aft dimension, pathologic increases of gait fluctuations critically depend on the locomotion speed and predominantly manifest during slow walking velocities. This feature is associated with an increased risk of falls in both patients with vestibular hypofunction as well as patients with cerebellar ataxia. Pharmacological approaches for the treatment of vestibular or cerebellar gait ataxia are currently not available. However, new promising options are currently tested in randomized, controlled trials (fampridine/FACEG; acetyl-DL-leucine/ALCAT).

Sarcoidosis Manifestion Centered on the Thalamic Pulvinar Leading to Persistent Astasia

“…The clinical syndrome, albeit sharing some features with cerebellar dysfunction (hypometric saccades), is also different from direct cerebellar lesions since our patient did not display gait ataxia (e.g., due to rostral vermis lesions which lead to a wide-based stance and gait). 10 Taken together, our results suggest that the pulvinar is critical for upright standing and walking. It likely subserves this role of postural signal integration through its widespread cortical and subcortical (i.e., cerebellar) connectivity.…”

“…We cannot completely rule out affection of the left CM in our patient (where the lesion extends slightly more anterior than on the right side), since the border of the CM to the pulvinar is not well defined even histologically, but we think that a major contribution of the CM to the astasia in our patient would have also led to a pathological SVV, which we did not detect. The clinical syndrome, albeit sharing some features with cerebellar dysfunction (hypometric saccades), is also different from direct cerebellar lesions since our patient did not display gait ataxia (e.g., due to rostral vermis lesions which lead to a wide‐based stance and gait) . Taken together, our results suggest that the pulvinar is critical for upright standing and walking.…”

Clinical characteristics of patients with essential tremor or essential tremor plus

“…Lobules VI‐VII within the vermis are part of the limbic cerebellum which participates in emotional processing; dysregulation in these areas can result in affective disorders . Meanwhile, vermis of the cerebellum is also involved in control of the midline balance . When vermis affected, patients are more likely to develop mental symptoms and may be accompanied by signs associated with balance disorders.…”

“…37,38 Meanwhile, vermis of the cerebellum is also involved in control of the midline balance. 12,39 When vermis affected, patients are more likely to develop mental symptoms and may be accompanied by signs associated with balance disorders. Whether these symptoms have the common pathophysiology basis remains to be explored.…”

Long Term Follow-Up Study with non-invasive brain stimulation (NBS) (rTMS and tDCS) in Parkinson’s disease (PD). Strong Age Dependency in the Effect of NBS

“…We may suppose that the rTMS stimulations over the brain stem and tDCS over both hemispheres of the cerebellum played a role in these favorable effects. The cerebellum also takes part in the motor and mental circuits (Schniepp et al, 2017;Mentis et al, 2003). Its important role in Parkinson's disease was reviewed by Wu and Hallett (2013).…”