Potential Non-invasive Brain Stimulation Targets to Alleviate Freezing of Gait in Parkinson’s Disease

Potvin‐Desrochers, Alexandra; Paquette, Caroline

doi:10.1016/j.neuroscience.2021.05.037

Cited by 13 publications

(8 citation statements)

References 119 publications

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“…Consequently, the thalamus and brainstem experience excessive inhibition, resulting in FOG. 36 SICI in PD Non-FOG patients was normal in this study. However, SICI studies in PD patients have yielded variable results.…”

Section: Discussionsupporting

confidence: 47%

“…These motor phenomena may share similar neurophysiological mechanisms, and the abnormality of motor cortex in FOG is not limited to M1‐LL. Further, rTMS over M1‐LL may improve FOG by not only affecting the stimulation site, but also modulating the linked brain areas and activity of the network (eg, M1‐UL or subcortical network) 36 . If the decrease in SICI at 4 milliseconds represents an imbalance between inhibitory and excitatory pathway, it may be facilitated by an increase of excitatory inputs to M1 from the SMA, dorsolateral prefrontal lobe, and other cortical areas 54 .…”

Section: Discussionmentioning

confidence: 99%

“…Increased cortical output leads to overload at damaged striatum in FOG patients, causing loss of inhibitory control of the globus pallidus interna (Gpi) by the striatum. Consequently, the thalamus and brainstem experience excessive inhibition, resulting in FOG 36 …”

Section: Discussionmentioning

confidence: 99%

“…Further, rTMS over M1-LL may improve FOG by not only affecting the stimulation site, but also modulating the linked brain areas and activity of the network (eg, M1-UL or subcortical network). 36 If the decrease in SICI at 4 milliseconds represents an imbalance between inhibitory and excitatory pathway, it may be facilitated by an increase of excitatory inputs to M1 from the SMA, dorsolateral prefrontal lobe, and other cortical areas. 54 Given that the M1-UL region is shallower, larger, and closer to the related cortical regions than the M1-LL, it may be more sensitive to detecting imbalances in inhibitory and excitatory pathways.…”

Section: S U N E T a Lmentioning

confidence: 99%

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Cortical Disinhibition Drives Freezing of Gait in Parkinson's Disease and an Exploratory Repetitive Transcranial Magnetic Stimulation Study

Sun,

Gan,

Wang

et al. 2023

Movement Disorders

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BackgroundDysfunction of the primary motor cortex, participating in regulation of posture and gait, is implicated in freezing of gait (FOG) in Parkinson's disease (PD).ObjectiveThe aim was to reveal the mechanisms of “OFF‐period” FOG (OFF‐FOG) and “levodopa‐unresponsive” FOG (ONOFF‐FOG) in PD.MethodsWe measured the transcranial magnetic stimulation (TMS) indicators and gait parameters in 21 healthy controls (HCs), 15 PD patients with ONOFF‐FOG, 15 PD patients with OFF‐FOG, and 15 PD patients without FOG (Non‐FOG) in “ON” and “OFF” medication conditions. Difference of TMS indicators in the four groups and two conditions and its correlations with gait parameters were explored. Additionally, we explored the effect of 10 Hz repetitive TMS on gait and TMS indicators in ONOFF‐FOG patients.ResultsIn “OFF” condition, short interval intracortical inhibition (SICI) exhibited remarkable attenuation in FOG patients (both ONOFF‐FOG and OFF‐FOG) compared to Non‐FOG patients and HCs. The weakening of SICI correlated with impaired gait characteristics in FOG. However, in “ON” condition, SICI in ONOFF‐FOG patients reduced compared to OFF‐FOG patients. Pharmacological treatment significantly improved SICI and gait in OFF‐FOG patients, and high‐frequency repetitive TMS distinctly improved gait in ONOFF‐FOG patients, accompanied by enhanced SICI.ConclusionsMotor cortex disinhibition, represented by decreased SICI, is related to FOG in PD. Refractory freezing in ONOFF‐FOG patients correlated with the their reduced SICI insensitive to dopaminergic medication. SICI can serve as an indicator of the severity of impaired gait characteristics in FOG and reflect treatments efficacy for FOG in PD patients. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

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Section: Discussionsupporting

confidence: 47%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: S U N E T a Lmentioning

confidence: 99%

See 2 more Smart Citations

Cortical Disinhibition Drives Freezing of Gait in Parkinson's Disease and an Exploratory Repetitive Transcranial Magnetic Stimulation Study

Sun,

Gan,

Wang

et al. 2023

Movement Disorders

View full text Add to dashboard Cite

show abstract

“…Transcranial direct current stimulation delivered over the primary motor cortex (M1) has been tested in several movement disorders with interesting, although sometimes conflicting, results ( 21 ). In idiopathic PD, t-DCS improved freezing of gait (FOG) and balance ( 22 , 23 ), upper limbs bradykinesia, writing and sequential movements ( 24 , 25 ), and severity of dyskinesia ( 26 ). However, this technique has never been tested in the management of patients with PD along with PS, although the central pathogenetic hypothesis appears to be particularly suitable to this approach.…”

Section: Introductionmentioning

confidence: 99%

Non-Invasive Neuromodulation in the Rehabilitation of Pisa Syndrome in Parkinson's Disease: A Randomized Controlled Trial

Icco

Putortì

Allena³

et al. 2022

Front. Neurol.

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BackgroundPisa syndrome (PS) is a frequent postural complication of Parkinson's disease (PD). PS poorly responds to anti-parkinsonian drugs and the improvement achieved with neurorehabilitation tends to fade in 6 months or less. Transcranial direct current stimulation (t-DCS) is a non-invasive neuromodulation technique that showed promising results in improving specific symptoms in different movement disorders.ObjectivesThis study aimed to evaluate the role of bi-hemispheric t-DCS as an add-on to a standardized hospital rehabilitation program in the management of PS in PD.MethodsThis study included 28 patients with PD and PS (21 men, aged 72.9 ± 5.1 years) who underwent a 4-week intensive neurorehabilitation treatment and were randomized to receive: i) t-DCS (t-DCS group, n = 13) for 5 daily sessions (20 min−2 mA) with bi-hemispheric stimulation over the primary motor cortex (M1), or ii) sham stimulation (sham group, n = 15) with the same duration and cadence. At baseline (T0), end of rehabilitation (T1), and 6 months later (T2) patients were evaluated with both trunk kinematic analysis and clinical scales, including UPDRS-III, Functional Independence Measure (FIM), and Numerical Rating Scale for lumbar pain.ResultsWhen compared to the sham group, the t-DCS group achieved a more pronounced improvement in several variables: overall posture (p = 0.014), lateral trunk inclination (p = 0.013) during upright standing position, total range of motion of the trunk (p = 0.012), FIM score (p = 0.048), and lumbar pain intensity (p = 0.017).ConclusionsOur data support the use of neuromodulation with t-DCS as an add-on to neurorehabilitation for the treatment of patients affected by PS in PD.

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Interventions to improve gait in Parkinson’s disease: a systematic review of randomized controlled trials and network meta-analysis

et al. 2022

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Potential Non-invasive Brain Stimulation Targets to Alleviate Freezing of Gait in Parkinson’s Disease

Cited by 13 publications

References 119 publications

Cortical Disinhibition Drives Freezing of Gait in Parkinson's Disease and an Exploratory Repetitive Transcranial Magnetic Stimulation Study

Cortical Disinhibition Drives Freezing of Gait in Parkinson's Disease and an Exploratory Repetitive Transcranial Magnetic Stimulation Study

Non-Invasive Neuromodulation in the Rehabilitation of Pisa Syndrome in Parkinson's Disease: A Randomized Controlled Trial

Interventions to improve gait in Parkinson’s disease: a systematic review of randomized controlled trials and network meta-analysis

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