The Pirouette Test to Evaluate Asymmetry in Parkinsonian Gait Freezing

Reich, Martin M.; Sawalhe, Anna Dalal; Steigerwald, Frank; Johannes, Silvia; Matthies, Cordula; Volkmann, Jens

doi:10.1002/mdc3.12018

Cited by 10 publications

(6 citation statements)

References 5 publications

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“…In addition, the selectivity of DBS within the VTA may be further improved by adjusting temporal parameters such as pulse width and frequency. 15,16 Moreover, within the target region, different symptoms tend to correspond to different substructures 7 (eg, tremor regions are distinct from bradykinesia regions). Directional leads enable further study of the structure and shape of the targets as well as the pathophysiological role of microstructures within by directing the VTA toward new subtargets.…”

Section: Clinical Opportunitiesmentioning

confidence: 99%

Directional leads for deep brain stimulation: Opportunities and challenges

et al. 2017

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Section: Clinical Opportunitiesmentioning

confidence: 99%

Directional leads for deep brain stimulation: Opportunities and challenges

et al. 2017

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“…Other therapeutic strategy such as subthalamic deep brain stimulation (STN-DBS) is not the leading option, because it is reserved to levodopa-responsive and not for levodopa-resistant features, although its dopa-sparing effect may alleviate ‘on’ FOG 7 8. Studies concerning the effects of STN-DBS on this subgroup of FOG patients are required.…”

Section: Discussionmentioning

confidence: 99%

Freezing of gait and postural instability: the unpredictable response to levodopa in Parkinson’s disease

Moreira¹,

Gomes

Januário

2019

BMJ Case Rep

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Freezing of gait (FOG) and postural instability are challenging motor symptoms that present a serious therapeutic dilemma in Parkinson’s disease. Appropriate distinction between FOG subtypes may be difficult during routine clinical visits, as shown in the case we present. The patient was examined in three different states in relation to levodopa (L-DOPA) and apomorphine subcutaneous (sc) tests with video documentation: (1) ‘overnight-off’, after 12 hours without medication; (2)‘on’, 60 min after intake of regular levodopa dose (200 mg) and 20 min after 2 mg of apomorphine sc; and (3) ‘supra-on’, after 350 mg of L-DOPA and 3 mg of apomorphine sc. The patient clearly showed a dose-dependent paradoxical response to L-DOPA treatment with the emergence of severe FOG and postural instability. The tendency to develop these axial symptoms was less pronounced with apomorphine at doses that achieved similar improvements of other Parkinsonian features.

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“…The clinical and pathophysiological interpretation of these DBS-associated gait impairments is complicated, and excessive reduction of dopaminergic therapy is required to distinguish between disease-related progression of axial motor symptoms or unmasking of a parkinsonian gait disorder and a stimulation-related, long-term adverse effect. 14 Several authors have previously reported that STN stimulation could have deleterious effects on axial symptoms, with a delayed onset of postural instability and gait disorders. 31,32 Interestingly, we observed de novo gait problems in a group of patients with an overall excellent response of parkinsonian motor symptoms to STN-DBS, as re ected by an average 59.6% reduction of the total UPDRS III score.…”

Section: Clinical Changes In Locomotion After Stn-dbsmentioning

confidence: 99%

Probabilistic mapping of gait changes after STN-DBS for Parkinson’s disease

Reich¹,

Nickl

Grossmann

et al. 2023

Preprint

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Objective. Gait disturbances causing impaired mobility are common in Parkinson’s disease after bilateral deep brain stimulation of the subthalamic nucleus. We describe subthalamic subregions where neurostimulation had a positive effect on gait or provoked gait disturbances. Methods. Sixty-eight patients were classified according to postoperative gait changes: (1) gait improvement, (2) no change, (3) de novo gait disturbances. We performed a segregation analysis for (1) and (3) by simulating volumes of tissue activated and comparing aggregated spatial data for the two groups and calculated probability maps to forecast gait performance and the parkinsonism control. Results. Twenty patients experienced complete remission of presurgical gait problems after stimulation. Nine patients showed de novo gait disturbances one year post-implantation. Active contacts were more ventrally located for de novo gait disturbances versus gait improvement. Strong correlations were found between clinical alterations in gait and the individual stimulation volume within the probabilistic outcome gait map (R2 = 0.78; p = 0.01), whereby clinical improvement in parkinsonism correlated with individual stimulation volume within the corresponding probabilistic outcome map (R2 = 0.39; p = 0.01). The probabilistic maps predict patients who experience long-term gait benefits based on their volume of tissue activated overlap, which was gait specific and showed no correlation with the global parkinsonism control heatmap. Interpretation. Probabilistic mapping showed high correlation for therapy outcomes, especially gait improvement. The concept of sweet- or badspots could not explain individual differences. The thin delineations between close substructures in the subthalamic nucleus correlated with individual gait changes after neurostimulation. Probabilistic mapping may direct future re-programming approaches for greater mobility in parkinsonian patients.

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The Pirouette Test to Evaluate Asymmetry in Parkinsonian Gait Freezing

Cited by 10 publications

References 5 publications

Directional leads for deep brain stimulation: Opportunities and challenges

Directional leads for deep brain stimulation: Opportunities and challenges

Freezing of gait and postural instability: the unpredictable response to levodopa in Parkinson’s disease

Probabilistic mapping of gait changes after STN-DBS for Parkinson’s disease

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