Neural correlates of gait variability in people with multiple sclerosis with fall history

Kalron, Alon; Allali, Gilles; Achiron, Anat

doi:10.1111/ene.13689

Cited by 13 publications

(10 citation statements)

References 34 publications

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“…Grey matter volumes of the putamen, caudate, globus pallidus and nucleus accumbens have been linked to the Timed 25‐ft Walk (T25FW) test in relapsing–remitting MS , whereas cerebellar volume has been associated with the T25FW test in primary progressive MS . Recently, an association between low left hippocampal, putamen volumes and step time variability was found in PwMS with a history of falls . In this context, the walk ratio may be advantageous as a marker of brain structure involved with locomotion, as it is an invariant feature of gait, allowing for an optimal balance between energy expenditure and forward propulsion for stability during walking .…”

Section: Introductionmentioning

confidence: 99%

Is the walk ratio a window to the cerebellum in multiple sclerosis? A structural magnetic resonance imaging study

Kalron

Menascu

Givon

et al. 2019

Euro J of Neurology

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Background and purpose Existing research studies have demonstrated a relationship between magnetic resonance imaging (MRI) neuroimaging measures and walking speed in people with multiple sclerosis (PwMS). However, to date there are no data as to the brain structures involved in gait coordination and control in PwMS. Therefore, the aim of our study was to investigate the association between walk ratio, an indicator of gait coordination, and related brain structures in PwMS. Methods A brain MRI was performed by a 3.0‐T MR scanner in conjunction with a volumetric analysis based on three‐dimensional T1‐weighted images. Regions of interest were volumes of the hippocampus, amygdala, putamen, caudate, pallidum, thalamus, cerebellum and the corpus callosum regions. Walking speed and walk ratio, defined as step length divided by step rate, was measured whilst walking on an electronic walkway. Results In all, 343 PwMS (41.1 ± 13.4 years, 69.1% female, median Expanded Disability Status Scale 2.5) were included in the study. A significant association was found between the left cerebellum volume and walk ratio after controlling for age, gender, total cranial volume and disability; R2 = 0.379, P = 0.002. A similar association was found between the right cerebellum volume and walk ratio, R2 = 0.364, P = 0.002. No correlations were observed between walk ratio and the thalamus, basal ganglia, hippocampus, amygdala and the corpus callosum volumes. No association was found between walking speed and all brain measures. Conclusions The walk ratio should be considered when evaluating and assessing PwMS presenting with ataxia. Furthermore, it is also hypothesized that a low walk ratio indicates a lower cerebellum volume in the MS population.

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Section: Introductionmentioning

confidence: 99%

Is the walk ratio a window to the cerebellum in multiple sclerosis? A structural magnetic resonance imaging study

Kalron

Menascu

Givon

et al. 2019

Euro J of Neurology

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“…The caudate nuclei have both behavioral and motor functions, including body and limb posture and controlling approach-attachment behaviors, respectively ( Kalron et al, 2020 ). Of note, the basal ganglia have strong anatomical and functional connections with the cortex, thalamus, and brainstem, and play a relevant role in initiating and controlling locomotion ( Villablanca, 2010 ; Onu et al, 2015 ; Kalron et al, 2018 , 2020 ). Previous studies examining the association between magnetic resonance imaging (MRI) measures and gait in PwMS have found that gray matter volume of the putamen, caudate, globus pallidus, and nucleus accumbens were all linked to the Timed 25-ft Walk (T25FW) test in relapsing-remitting MS ( Alexander et al, 1990 ; Onu et al, 2015 ), whereas cerebellar volume was associated with the T25FW test in primary progressive MS ( Alexander et al, 1990 ; Bhatia and Marsden, 1994 ).…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies examining the association between magnetic resonance imaging (MRI) measures and gait in PwMS have found that gray matter volume of the putamen, caudate, globus pallidus, and nucleus accumbens were all linked to the Timed 25-ft Walk (T25FW) test in relapsing-remitting MS ( Alexander et al, 1990 ; Onu et al, 2015 ), whereas cerebellar volume was associated with the T25FW test in primary progressive MS ( Alexander et al, 1990 ; Bhatia and Marsden, 1994 ). Moreover, Kalron et al (2018) reported that PwMS with a history of falls exhibited reduced left caudate volume compared to non-fallers.…”

Section: Discussionmentioning

confidence: 99%

On the Effects of Transcranial Direct Current Stimulation on Cerebral Glucose Uptake During Walking: A Report of Three Patients With Multiple Sclerosis

Rudroff

Fietsam

Deters

et al. 2022

Front. Hum. Neurosci.

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Common symptoms of multiple sclerosis (MS) include motor impairments of the lower extremities, particularly gait disturbances. Loss of balance and muscle weakness, representing some peripheral effects, have been shown to influence these symptoms, however, the individual role of cortical and subcortical structures in the central nervous system is still to be understood. Assessing [18F]fluorodeoxyglucose (FDG) uptake in the CNS can assess brain activity and is directly associated with regional neuronal activity. One potential modality to increase cortical excitability and improve motor function in patients with MS (PwMS) is transcranial direct current stimulation (tDCS). However, tDCS group outcomes may not mirror individual subject responses, which impedes our knowledge of the pathophysiology and management of diseases like MS. Three PwMS randomly received both 3 mA tDCS and SHAM targeting the motor cortex (M1) that controls the more-affected leg for 20 min on separate days before walking on a treadmill. The radiotracer, FDG, was injected at minute two of the 20 min walk and the subjects underwent a Positron emission tomography (PET) scan immediately after the task. Differences in relative regional metabolism of areas under the tDCS anode and the basal ganglia were calculated and investigated. The results indicated diverse and individualized responses in regions under the anode and consistent increases in some basal ganglia areas (e.g., caudate nucleus). Thus, anodal tDCS targeting the M1 that controls the more-affected leg of PwMS might be capable of affecting remote subcortical regions and modulating the activity (motor, cognitive, and behavioral functions) of the circuitry connected to these regions.

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“…Gait variability has been shown to differentiate between both individuals with MS and healthy controls and MS fallers and non-fallers [44], as well as being linked to disability level, fatigue, and attention in persons with MS [45]. Therefore, the association between SMA DTI measures with gait variability (CVs) is particularly relevant, and represents a novel finding among persons with MS. A recent imaging study demonstrated relationships among increased gait variability and lower hippocampal and putamen volumes in MS fallers, but no DTI measures or tract-specific imaging was performed [46]. The relationship between higher gait variability and poorer SMA tract integrity and not with gait speed and spatiotemporal measures builds upon work by Hausdorff et al, who reported that gait variability (also referred to as unsteadiness or inconsistency and arrhythmicity of stepping) was closely associated with risk of falls in the elderly and in people with Parkinson's disease, whereas measures of gait speed and average gait cycle timing did not discriminate future fallers from non-fallers [47,48].…”

Section: Discussionmentioning

confidence: 99%

Supplementary motor area connectivity and dual-task walking variability in multiple sclerosis

Fritz

Kloos

Kegelmeyer

et al. 2019

Journal of the Neurological Sciences

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Background.-Despite the prevalence of dual-task (e.g., walking while talking) deficits in people with multiple sclerosis (MS), no neuroimaging studies to date have examined neuronal networks used for dual-task processing or specific brain areas related to dual-task performance in this population. A better understanding of the relationship among underlying brain areas and dualtask performance may improve targeted rehabilitation programs. The objective of this study was to examine relationships between neuroimaging measures and clinical measures of dual-task performance, and reported falls in persons with MS. Materials and methods.-All participants completed measures of dual-task performance, a fall history, and neuroimaging on a 3T MRI scanner. Spearman correlations were used to examine relationships among dual-task performance, falls and neuroimaging measures. Results.-Eighteen females with relapsing-remitting MS [mean age= 45.5 ± 8.2 SD; mean symptom duration = 12.3±6.7 years; Expanded Disability Status Scale median 2.25 (range 1.5-4)] participated in this study. Structural imaging measures of supplementary motor area (SMA) interhemispheric connectivity were significantly related to dual-task walking variability. Conclusions.-The SMA interhemispheric tract may play a role in dual-task performance. Structural neuroimaging may be a useful adjunct to clinical measures to predict performance and provide information about recovery patterns in MS. Functional recovery can be challenging to *

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Neural correlates of gait variability in people with multiple sclerosis with fall history

Abstract: An association between low left hippocampal, putamen volumes and step time variability was found in PwMS with a history of falls, suggesting that brain structural characteristics may be related to falls and increased gait variability in PwMS.

Cited by 13 publications

References 34 publications

Is the walk ratio a window to the cerebellum in multiple sclerosis? A structural magnetic resonance imaging study

Is the walk ratio a window to the cerebellum in multiple sclerosis? A structural magnetic resonance imaging study

On the Effects of Transcranial Direct Current Stimulation on Cerebral Glucose Uptake During Walking: A Report of Three Patients With Multiple Sclerosis

Supplementary motor area connectivity and dual-task walking variability in multiple sclerosis

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