Unraveling the threads of stability: A review of the neurophysiology of postural control in Parkinson's disease

Although high-frequency deep brain stimulation (DBS) is effective at relieving many motor symptoms of Parkinson's disease (PD), its effects on gait can be variable and unpredictable. This is due to 1) a lack of standardized and robust metrics for gait assessment in PD patients, 2) the challenges of performing a thorough evaluation of all the stimulation parameters space that can alter gait, and 3) a lack of understanding for impacts of stimulation on the neurophysiological signatures of walking. In this study, our goal was to develop a data-driven approach to identify optimal, personalized DBS stimulation parameters to improve gait in PD patients and identify the neurophysiological signature of improved gait. Local field potentials from the globus pallidus and electrocorticography from the motor cortex of three PD patients were recorded using an implanted bidirectional neural stimulator during overground walking. A walking performance index (WPI) was developed to assess gait metrics with high reliability. DBS frequency, amplitude, and pulse width on the "clinically optimized" stimulation contact were then systemically changed to study their impacts on gait metrics and underlying neural dynamics. We developed a Gaussian Process Regressor (GPR) model to map the relationship between DBS settings and the WPI. Using this model, we identified and validated personalized DBS settings that significantly improved gait metrics. Linear mixed models were employed to identify neural spectral features associated with enhanced walking performance. We demonstrated that improved walking performance was linked to the modulation of neural activity in specific frequency bands, with reduced beta band power in the pallidum and increased alpha band pallidal-motor cortex coherence synchronization during key moments of the gait cycle. Integrating WPI and GPR to optimize DBS parameters underscores the importance of developing and understanding personalized, data-driven interventions for gait improvement in PD.

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Assessing Brain Network Dynamics during Postural Control Task using EEG Microstates

Gelormini,

Guerrini,

Pescaglia

et al. 2024

Preprint

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The ability to maintain our body’s balance and stability in space is crucial for performing daily activities. Effective postural control (PC) strategies rely on integrating visual, vestibular, and proprioceptive sensory inputs. While neuroimaging has revealed key areas involved in PC—including brainstem, cerebellum, and cortical networks—the rapid neural mechanisms underlying dynamic postural tasks remain less understood. Therefore, we used EEG microstate analysis within the BioVRSea experiment to explore the temporal brain dynamics that support PC. This complex paradigm simulates maintaining an upright posture on a moving platform, integrated with virtual reality (VR), to replicate the sensation of balancing on a boat. Data were acquired from 266 healthy subjects using a 64-channel EEG system. Using a modified k-means method, five EEG microstate maps were identified to best model the paradigm. Differences in each microstate maps feature (occurrence, duration, and coverage) between experimental phases were analyzed using a linear mixed model, revealing significant differences between microstates within the experiment phases. The temporal parameters of microstate C showed significantly higher levels in all experimental phases compared to other microstate maps, whereas microstate B displayed an opposite pattern, consistently showing lower levels. This study marks the first attempt to use microstate analysis during a dynamic task, demonstrating the decisive role of microstate C and, conversely, microstate B in differentiating the PC phases. These results demonstrate the use of microstate technique for studying temporal brain dynamics during PC with potential application in the early detection of neurodegenerative diseases.

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Unraveling the threads of stability: A review of the neurophysiology of postural control in Parkinson's disease

Cited by 3 publications

References 152 publications

Parkinsonism: Clinical Features and Diagnostic Framework

Parkinsonism: Clinical Features and Diagnostic Framework

Modeling and Optimizing Deep Brain Stimulation to Enhance Gait in Parkinson’s Disease: Personalized Treatment with Neurophysiological Insights

Assessing Brain Network Dynamics during Postural Control Task using EEG Microstates

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