Suppa Antonio, Kita Ardian, Leodori Giorgio, Zampogna Alessandro, Nicolini Ettore, Lorenzi Paolo, Rao Rosario, Irrera Fernanda
Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy.
IRCCS Neuromed Institute, Pozzilli, Italy.
Front Neurol. 2017 Aug 14;8:406. doi: 10.3389/fneur.2017.00406. eCollection 2017.
Freezing of gait (FOG) is a leading cause of falls and fractures in Parkinson's disease (PD). The episodic and rather unpredictable occurrence of FOG, coupled with the variable response to l-DOPA of this gait disorder, makes the objective evaluation of FOG severity a major clinical challenge in the therapeutic management of patients with PD. The aim of this study was to examine and compare gait, clinically and objectively, in patients with PD, with and without FOG, by means of a new wearable system. We also assessed the effect of l-DOPA on FOG severity and specific spatiotemporal gait parameters in patients with and without FOG. To this purpose, we recruited 28 patients with FOG, 16 patients without FOG, and 16 healthy subjects. In all participants, gait was evaluated clinically by video recordings and objectively by means of the wearable wireless system, during a modified 3-m Timed Up and Go (TUG) test. All patients performed the modified TUG test under and not under dopaminergic therapy (ON and OFF therapy). By comparing instrumental data with the clinical identification of FOG based on offline video-recordings, we also assessed the performance of the wearable system to detect FOG automatically in terms of sensitivity, specificity, positive and negative predictive values, and finally accuracy. TUG duration was longer in patients than in controls, and the amount of gait abnormalities was prominent in patients with FOG compared with those without FOG. l-DOPA improved gait significantly in patients with PD and particularly in patients with FOG mainly by reducing FOG duration and increasing specific spatiotemporal gait parameters. Finally, the overall wireless system performance in automatic FOG detection was characterized by excellent sensitivity (93.41%), specificity (98.51%), positive predictive value (89.55%), negative predictive value (97.31%), and finally accuracy (98.51%). Our study overall provides new information on the beneficial effect of l-DOPA on FOG severity and specific spatiotemporal gait parameters as objectively measured by a wearable sensory system. The algorithm here reported potentially opens to objective long-time sensing of FOG episodes in patients with PD.
冻结步态（FOG）是帕金森病（PD）患者跌倒和骨折的主要原因。FOG发作具有偶发性且相当不可预测，再加上这种步态障碍对左旋多巴的反应各异，使得对FOG严重程度进行客观评估成为PD患者治疗管理中的一项重大临床挑战。本研究的目的是通过一种新型可穿戴系统，从临床和客观角度检查并比较有和没有FOG的PD患者的步态。我们还评估了左旋多巴对有和没有FOG的患者的FOG严重程度以及特定时空步态参数的影响。为此，我们招募了28名有FOG的患者、16名没有FOG的患者以及16名健康受试者。在所有参与者中，在改良的3米定时起立行走（TUG）测试期间，通过视频记录对步态进行临床评估，并通过可穿戴无线系统进行客观评估。所有患者在多巴胺能治疗状态下（开和关治疗）都进行了改良TUG测试。通过将仪器数据与基于离线视频记录的FOG临床识别结果进行比较，我们还从灵敏度、特异性、阳性和阴性预测值以及最终的准确性方面评估了可穿戴系统自动检测FOG的性能。患者的TUG持续时间比对照组更长，与没有FOG的患者相比，有FOG的患者步态异常程度更为明显。左旋多巴显著改善了PD患者的步态，特别是有FOG的患者，主要是通过缩短FOG持续时间并增加特定时空步态参数。最后，自动检测FOG的整个无线系统性能表现为具有出色的灵敏度（93.41%）、特异性（98.51%）、阳性预测值（89.55%）、阴性预测值（97.31%）以及最终的准确性（98.51%）。我们的研究总体上提供了关于左旋多巴对FOG严重程度以及可穿戴传感系统客观测量的特定时空步态参数有益影响的新信息。此处报告的算法可能为客观长期感知PD患者的FOG发作开启大门。
