Melanie Heilbronn1, Marlieke Scholten1, Christian Schlenstedt2, Martina Mancini3, Anna Schöllmann1, Idil Cebi1, Monika Pötter-Nerger4, Alireza Gharabaghi5, Daniel Weiss6. 1. Department of Neurodegenerative Diseases and Hertie Institute for Clinical Brain Research (HIH), University of Tuebingen, Germany; German Centre of Neurodegenerative Diseases (DZNE), University of Tuebingen, Tuebingen, Germany. 2. Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany. 3. Balance Disorders Laboratory, Oregon Health & Science University, Portland, OR, United States. 4. Department of Neurology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany. 5. Division of Functional and Restorative Neurosurgery, Department of Neurosurgery, and Werner Reichardt Centre for Integrative Neuroscience, University of Tuebingen, Tuebingen, Germany. 6. Department of Neurodegenerative Diseases and Hertie Institute for Clinical Brain Research (HIH), University of Tuebingen, Germany; German Centre of Neurodegenerative Diseases (DZNE), University of Tuebingen, Tuebingen, Germany. Electronic address: daniel.weiss@uni-tuebingen.de.
Abstract
BACKGROUND: A precise understanding of the neuronal circuits involved in the control of anticipatory postural adjustments (APAs) for gait initiation is missing. Neurostimulation in Parkinson's disease (PD) provides a method of modulating APAs to gain insight into the underlying circuitry. OBJECTIVE: Our objective was to investigate if APA kinematics for step initiation could be modulated by high frequency stimulation of the subthalamic nucleus (STN) or substantia nigra pars reticulata (SNr) in people with PD and freezing of gait (FoG). METHODS: We studied 14 people with PD and FoG using neurostimulation of the STN and SNr areas after overnight withdrawal of dopaminergic medication on the instrumented stand and walk test. We tested patients in the following randomized conditions: 'off stimulation', 'STN' stimulation (only), and 'SNr' stimulation (only). Patients were blinded to the stimulation condition. The APAs were recorded with inertial sensors and processed offline. Moreover, we assessed clinical scores with respect to motor symptoms, non-motor symptoms, executive function, and FoG. RESULTS: SNr but not STN stimulation modulated the anterio-posterior size of APA. The SNr modulation of APA was associated with the stimulation effect on FoG (trend; r = 0.580, P = 0.102). The APA modulation was not correlated with any other cognitive or clinical measures. CONCLUSION: Neuromodulation of the SNr but not of the STN modulated APAs in PD patients with FoG. The different effects of STN or SNr on the kinematic parameters of APA support the concept of segregate targets in order to address diverse kinematic components of PD gait.
BACKGROUND: A precise understanding of the neuronal circuits involved in the control of anticipatory postural adjustments (APAs) for gait initiation is missing. Neurostimulation in Parkinson's disease (PD) provides a method of modulating APAs to gain insight into the underlying circuitry. OBJECTIVE: Our objective was to investigate if APA kinematics for step initiation could be modulated by high frequency stimulation of the subthalamic nucleus (STN) or substantia nigra pars reticulata (SNr) in people with PD and freezing of gait (FoG). METHODS: We studied 14 people with PD and FoG using neurostimulation of the STN and SNr areas after overnight withdrawal of dopaminergic medication on the instrumented stand and walk test. We tested patients in the following randomized conditions: 'off stimulation', 'STN' stimulation (only), and 'SNr' stimulation (only). Patients were blinded to the stimulation condition. The APAs were recorded with inertial sensors and processed offline. Moreover, we assessed clinical scores with respect to motor symptoms, non-motor symptoms, executive function, and FoG. RESULTS: SNr but not STN stimulation modulated the anterio-posterior size of APA. The SNr modulation of APA was associated with the stimulation effect on FoG (trend; r = 0.580, P = 0.102). The APA modulation was not correlated with any other cognitive or clinical measures. CONCLUSION: Neuromodulation of the SNr but not of the STN modulated APAs in PDpatients with FoG. The different effects of STN or SNr on the kinematic parameters of APA support the concept of segregate targets in order to address diverse kinematic components of PD gait.
Authors: Sina R Potel; Sara Marceglia; Sara Meoni; Suneil K Kalia; Rubens G Cury; Elena Moro Journal: Curr Neurol Neurosci Rep Date: 2022-07-15 Impact factor: 6.030
Authors: Jumes Leopoldino Oliveira Lira; Carlos Ugrinowitsch; Daniel Boari Coelho; Luis Augusto Teixeira; Andrea Cristina de Lima-Pardini; Fernando Henrique Magalhães; Egberto Reis Barbosa; Fay B Horak; Carla Silva-Batista Journal: J Physiol Date: 2020-03-12 Impact factor: 5.182