Fasano Alfonso, Herman Talia, Tessitore Alessandro, Strafella Antonio P, Bohnen Nicolaas I
Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, University Health Network, Toronto, ON, Canada.
Center for the study of Movement, Cognition and Mobility, Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
J Parkinsons Dis. 2015;5(2):241-54. doi: 10.3233/JPD-150536.
Functional brain imaging techniques appear ideally suited to explore the pathophysiology of freezing of gait (FOG). In the last two decades, techniques based on magnetic resonance or nuclear medicine imaging have found a number of structural changes and functional disconnections between subcortical and cortical regions of the locomotor network in patients with FOG. FOG seems to be related in part to disruptions in the "executive-attention" network along with regional tissue loss including the premotor area, inferior frontal gyrus, precentral gyrus, the parietal and occipital areas involved in visuospatial functions of the right hemisphere. Several subcortical structures have been also involved in the etiology of FOG, principally the caudate nucleus and the locomotor centers in the brainstem. Maladaptive neural compensation may present transiently in the presence of acute conflicting motor, cognitive or emotional stimulus processing, thus causing acute network overload and resulting in episodic impairment of stepping.In this review we will summarize the state of the art of neuroimaging research for FOG. We will also discuss the limitations of current approaches and delineate the next steps of neuroimaging research to unravel the pathophysiology of this mysterious motor phenomenon.
功能性脑成像技术似乎非常适合用于探究步态冻结（FOG）的病理生理学。在过去二十年中，基于磁共振或核医学成像的技术已经发现，FOG患者的运动网络皮质下区域和皮质区域之间存在一些结构变化和功能失联。FOG似乎部分与“执行-注意力”网络的破坏以及包括运动前区、额下回、中央前回、右半球参与视觉空间功能的顶叶和枕叶区域在内的局部组织损失有关。几个皮质下结构也参与了FOG的病因，主要是尾状核和脑干中的运动中枢。在存在急性冲突的运动、认知或情感刺激处理时，适应性不良的神经补偿可能会短暂出现，从而导致急性网络过载并导致间歇性步态障碍。在本综述中，我们将总结FOG神经成像研究的现状。我们还将讨论当前方法的局限性，并勾勒出神经成像研究的下一步，以阐明这种神秘运动现象的病理生理学。
