Functional Neuroanatomy for Posture and Gait Control

Journal of Movement Disorders, Journal Year: 2017, Volume and Issue: 10(1), P. 1 - 17

Published: Jan. 18, 2017

Here we argue functional neuroanatomy for posture-gait control.Multi-sensory information such as somatosensory, visual and vestibular sensation act on various areas of the brain so that adaptable control can be achieved.Automatic process gait, which is steady-state stepping movements associating with postural reflexes including headeye coordination accompanied by appropriate alignment body segments optimal level muscle tone, mediated descending pathways from brainstem to spinal cord.Particularly, reticulospinal arising lateral part mesopontine tegmentum locomotor network contribute this process.On other hand, walking in unfamiliar circumstance requires cognitive control, depends knowledges self-body, schema motion space.The produced at temporoparietal association cortex, fundamental sustention vertical posture construction motor programs.The programs cortical run execute anticipatory adjustment achievement goal-directed movements.The basal ganglia cerebellum may affect both automatic processes posturegait through reciprocal connections cerebral respectively.Consequently, impairments function damages disturb resulting falling.

Language: Английский

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Emerging therapies in Parkinson disease — repurposed drugs and new approaches

Nature Reviews Neurology, Journal Year: 2019, Volume and Issue: 15(4), P. 204 - 223

Published: March 12, 2019

Language: Английский

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Neurostimulation Devices for the Treatment of Neurologic Disorders

Mayo Clinic Proceedings, Journal Year: 2017, Volume and Issue: 92(9), P. 1427 - 1444

Published: Sept. 1, 2017

Language: Английский

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Cholinergic system changes of falls and freezing of gait in Parkinson's disease

Annals of Neurology, Journal Year: 2019, Volume and Issue: 85(4), P. 538 - 549

Published: Feb. 5, 2019

Objective Postural instability and gait difficulties (PIGDs) represent debilitating disturbances in Parkinson's disease (PD). Past acetylcholinesterase positron emission tomography (PET) imaging studies implicate cholinergic changes as significant contributors to PIGD features. These were limited quantification of striatal synapse integrity. Vesicular acetylcholine transporter (VAChT) PET ligands are better suited for evaluation high binding areas. We examined associations between regional VAChT expression freezing (FoG) falls. Methods Ninety‐four PD subjects underwent clinical assessment ([ 18 F]FEOBV) PET. Results Thirty‐five (37.2%) reported a history falls, 15 (16%) had observed FoG. Univariate volume‐of‐interest analyses demonstrated significantly reduced thalamic ( p = 0.0016) fallers compared nonfallers. was the striatum 0.0012) limbic archicortex 0.004) freezers nonfreezers. Whole‐brain voxel‐based FEOBV complemented these findings showed more granular associated with falling history, including right visual thalamus (especially lateral geniculate nucleus [LGN]), caudate nucleus, bilateral prefrontal regions. Freezers prominent reductions striatum, temporal, mesiofrontal Interpretation Our confirm extend on previous deficits now emphasize complex changes, LGN. FoG status is interneurons archicortex. observations suggest different systems underlying falls PD. Ann Neurol 2019;85:538–549

Language: Английский

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Freezing of gait in Parkinson’s disease: pathophysiology, risk factors and treatments

Translational Neurodegeneration, Journal Year: 2020, Volume and Issue: 9(1)

Published: April 15, 2020

Abstract Background Freezing of gait (FOG) is a common, disabling symptom Parkinson’s disease (PD), but the mechanisms and treatments FOG remain great challenges for clinicians researchers. The main focus this review to summarize possible underlying FOG, risk factors screening predicting onset clinical trials involving various therapeutic strategies. In addition, limitations recommendations future research design are also discussed. Main body mechanism section, we briefly introduced physiological process control hypotheses about FOG. factor disorders, PIGD phenotype, lower striatal DAT uptake were found be independent with consistent evidence. treatment summarized pharmacological non-pharmacological treatments. Despite limited effectiveness current medications especially levodopa resistant there some drugs that showed promise such as istradefylline rasagiline. Non-pharmacological encompass invasive brain spinal cord stimulation, noninvasive repetitive transcranial magnetic stimulation (rTMS) or direct (tDCS) vagus nerve (VNS), physiotherapeutic approaches including cues other training Several novel strategies seem effective, rTMS over supplementary motor area (SMA), dual-site DBS, (SCS) VNS. Of physiotherapy, wearable cueing devices generally effective promising. Conclusion model helpful better understanding characterizing they provide clues further exploration. have been identified, need combinatorial optimization more precisely. Although firm conclusions cannot drawn on efficacy, literature suggested promise.

Language: Английский

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A spinal cord neuroprosthesis for locomotor deficits due to Parkinson’s disease

Nature Medicine, Journal Year: 2023, Volume and Issue: 29(11), P. 2854 - 2865

Published: Nov. 1, 2023

Language: Английский

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The functional network signature of heterogeneity in freezing of gait

Brain, Journal Year: 2018, Volume and Issue: 141(4), P. 1145 - 1160

Published: Jan. 22, 2018

Freezing of gait is a complex, heterogeneous, and highly variable phenomenon whose pathophysiology neural signature remains enigmatic. Evidence suggests that freezing associated with impairments across cognitive, motor affective domains; however, most research to date has focused on investigating one axis in isolation. This led inconsistent findings range different pathophysiological models gait, due large part the tendency for studies investigate as homogeneous entity. To mechanisms this heterogeneity, we used an established virtual reality paradigm elicit behaviour 41 Parkinson's disease patients examined individual differences component processes (i.e. function) underlie conjunction task-based functional MRI. First, combined three unique components phenotype: impaired set-shifting ability, step time variability, self-reported anxiety depression principal analysis estimate severity multivariate approach. By combining these measures, were then able interrogate pattern connectivity (compared normal foot tapping) sub-cohort 20 participants who experienced sufficient amounts during task Specifically, first from our behavioural classify patterns into those with: (i) increased severity; (ii) compensation; or (iii) independent severity. Coupling between cognitive limbic networks was 'worse severity', whereas anti-coupling putamen related 'increased compensation'. Additionally, cortical regions caudate nucleus 'independent severity' thus may represent common underpinnings are unaffected by heterogenous factors. Finally, each (cognitive, motor, affective) turn, exposing latent heterogeneity phenotype, while also identifying critical network signatures potential targets novel therapeutic intervention. In conclusion, provide confirmatory evidence systems-level further advance understanding whole-brain deficits mediate symptom expression disease.

Language: Английский

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Freezing of gait: understanding the complexity of an enigmatic phenomenon

Brain, Journal Year: 2019, Volume and Issue: 143(1), P. 14 - 30

Published: Oct. 8, 2019

Abstract Diverse but complementary methodologies are required to uncover the complex determinants and pathophysiology of freezing gait. To develop future therapeutic avenues, we need a deeper understanding disseminated functional-anatomic network its temporally associated dynamic processes. In this targeted review, will summarize latest advances across multiple methodological domains including clinical phenomenology, neurogenetics, multimodal neuroimaging, neurophysiology, neuromodulation. We found that (i) locomotor vulnerability is established by structural damage, e.g. from neurodegeneration possibly as result genetic variability, or variable degree brain lesions. This leads an enhanced susceptibility, where (ii) modulators can both increase decrease threshold express Consequent decrease, (iii) neuronal integration failure multilevel occur affect one numerous nodes projections network. Finally, (iv) ultimate pathway might encounter effective motor output give rise gait endpoint. conclusion, derive key questions review challenge pathophysiological view. suggest research on these should lead improved insight strategies.

Language: Английский

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Recent developments in the treatment of Parkinson's Disease

F1000Research, Journal Year: 2020, Volume and Issue: 9, P. 862 - 862

Published: July 31, 2020

Parkinson's disease (PD) is a common neurodegenerative typified by movement disorder consisting of bradykinesia, rest tremor, rigidity, and postural instability. Treatment options for PD are limited, with most the current approaches based on restoration dopaminergic tone in striatum. However, these do not alter course treat non-dopamine-dependent features such as freezing gait, cognitive impairment, other non-motor disorder, which often have greatest impact quality life. As understanding pathogenesis grows, novel therapeutic avenues emerging. These include treatments that aim to control symptoms without problematic side effects seen currently available those aimed towards slowing pathology, reducing neuronal loss, attenuating course. In this latter regard, there has been much interest drug repurposing (the use established drugs new indication), many being reported affect PD-relevant intracellular processes. This approach offers an expedited route clinic, given pharmacokinetic safety data potentially already available. terms better symptomatic therapies also regenerative, gene cell-based beginning enter clinical trials, developments neurosurgical strategies more nuanced deep brain stimulation mean landscape treatment likely evolve considerably over coming years. review, we provide overview close to, or in, trials.

Language: Английский

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Freezing of gait in Parkinson’s disease reflects a sudden derangement of locomotor network dynamics

Brain, Journal Year: 2019, Volume and Issue: 142(7), P. 2037 - 2050

Published: May 27, 2019

Freezing of gait is a disabling symptom Parkinson's disease that causes paroxysmal inability to generate effective stepping. The underlying pathophysiology has recently migrated towards dysfunctional supraspinal locomotor network, but the actual network derangements during ongoing freezing are unknown. We investigated communication between cortex and subthalamic nucleus, two main nodes in seven freely-moving subjects with novel deep brain stimulation device, which allows on-demand recording neural activity from chronically-implanted electrodes months after surgical procedure. Multisite neurophysiological recordings (effective) walking were combined kinematic measurements individual molecular imaging studies. Patients walked supervised environment closely resembling everyday life challenges. found walking, nucleus synchronized low frequency band (4-13 Hz). In contrast, was characterized every patient by cortical-subthalamic decoupling hemisphere less striatal dopaminergic innervation. Of relevance, this already evident at transition normal into freezing, maintained episode, resolved recovery pattern. This first evidence for decoding networked processing locomotion suggests 'circuitopathy' related cortical-subcortical communication. A successful therapeutic approach should aim directly targeting dynamics.

Language: Английский

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