Stanford University, Department of Neurology and Neurological Sciences, Rm H3136, SUMC, 300 Pasteur Drive, Stanford, CA 94305, USA.
Stanford University, Department of Neurology and Neurological Sciences, Rm H3136, SUMC, 300 Pasteur Drive, Stanford, CA 94305, USA; Stanford University, Department of Neurosurgery, 300 Pasteur Drive, Stanford, CA 94305, USA.
Neurobiol Dis. 2017 Dec;108:288-297. doi: 10.1016/j.nbd.2017.09.002. Epub 2017 Sep 7.
The goal of this study was to investigate subthalamic (STN) neural features of Freezers and Non-Freezers with Parkinson's disease (PD), while freely walking without freezing of gait (FOG) and during periods of FOG, which were better elicited during a novel turning and barrier gait task than during forward walking.
Synchronous STN local field potentials (LFPs), shank angular velocities, and ground reaction forces were measured in fourteen PD subjects (eight Freezers) off medication, OFF deep brain stimulation (DBS), using an investigative, implanted, sensing neurostimulator (Activa® PC+S, Medtronic, Inc.). Tasks included standing still, instrumented forward walking, stepping in place on dual forceplates, and instrumented walking through a turning and barrier course.
During locomotion without FOG, Freezers showed lower beta (13-30Hz) power (P=0.036) and greater beta Sample Entropy (P=0.032), than Non-Freezers, as well as greater gait asymmetry and arrhythmicity (P<0.05 for both). No differences in alpha/beta power and/or entropy were evident at rest. During periods of FOG, Freezers showed greater alpha (8-12Hz) Sample Entropy (P<0.001) than during walking without FOG.
A novel turning and barrier course was superior to FW in eliciting FOG. Greater unpredictability in subthalamic beta rhythms was evident during stepping without freezing episodes in Freezers compared to Non-Freezers, whereas greater unpredictability in alpha rhythms was evident in Freezers during FOG. Non-linear analysis of dynamic neural signals during gait in freely moving people with PD may yield greater insight into the pathophysiology of FOG; whether the increases in STN entropy are causative or compensatory remains to be determined. Some beta LFP power may be useful for rhythmic, symmetric gait and DBS parameters, which completely attenuate STN beta power may worsen rather than improve FOG.
本研究旨在探讨帕金森病（PD）冷冻和非冷冻患者的丘脑底核（STN）神经特征，同时在无冻结步态（FOG）和FOG 期间自由行走，在新型转弯和障碍步态任务中，FOG 更易诱发。
14 名 PD 患者（8 名冷冻患者）在停药、关闭深部脑刺激（DBS）状态下，使用植入式、感应式神经刺激器（Activa® PC+S，美敦力公司）同步测量 STN 局部场电位（LFP）、柄角速度和地面反力。任务包括站立不动、仪器化向前行走、在双力板上原地踏步、以及通过转弯和障碍通道进行仪器化行走。
在无 FOG 的运动过程中，冷冻患者的β（13-30Hz）功率（P=0.036）和β样本熵（P=0.032）较低，步态不对称性和不规则性较大（均为 P<0.05）。在静止时，α/β功率和/或熵无差异。在 FOG 期间，冷冻患者的α样本熵（P<0.001）大于无 FOG 时的行走。
新型转弯和障碍课程比 FW 更能诱发 FOG。与非冷冻患者相比，冷冻患者在无冻结发作时的踏步过程中，STNβ节律的不可预测性更大，而在 FOG 期间，α节律的不可预测性更大。对 PD 自由活动患者步态动态神经信号的非线性分析可能会深入了解 FOG 的病理生理学；STN 熵的增加是因果关系还是补偿性的仍有待确定。一些βLFP 功率可能对节律性、对称性步态和 DBS 参数有用，完全衰减 STNβ功率可能会使 FOG 恶化而不是改善。
