Centre of Mathematics, Computation and Cognition, Federal University of ABC, São Paulo, Brazil.
Human Motor Systems Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil.
Elife. 2018 Aug 2;7:e37727. doi: 10.7554/eLife.37727.
Freezing of gait (FoG) in Parkinson's disease (PD) is an incapacitating transient phenomenon, followed by continuous postural disorders. Spinal cord stimulation (SCS) is a promising intervention for FoG in patients with PD, however, its effects on distinct domains of postural control is not well known. The aim of this study is to assess the effects of SCS on FoG and distinct domains of postural control. Four patients with FoG were implanted with SCS systems in the upper thoracic spine. Anticipatory postural adjustment (APA), reactive postural responses, gait and FoG were biomechanically assessed. In general, the results showed that SCS improved FoG and APA. However, SCS failed to improve reactive postural responses. SCS seems to influence cortical motor circuits, involving the supplementary motor area. On the other hand, reactive posture control to external perturbation that mainly relies on neuronal circuitries involving the brainstem and spinal cord, is less influenced by SCS.
冻结步态（Freezing of gait, FoG）是帕金森病（Parkinson's disease, PD）患者一种致残性的短暂现象，随后会出现持续性姿势障碍。脊髓刺激（Spinal cord stimulation, SCS）是治疗 PD 患者 FoG 的一种有前途的干预手段，然而，其对不同姿势控制领域的影响尚不清楚。本研究旨在评估 SCS 对 FoG 和不同姿势控制领域的影响。4 名 FoG 患者在上胸段植入 SCS 系统。采用生物力学评估了姿势预备调整（Anticipatory postural adjustment, APA）、反应性姿势反应、步态和 FoG。总的来说，结果表明 SCS 改善了 FoG 和 APA。然而，SCS 未能改善反应性姿势反应。SCS 似乎影响皮质运动回路，涉及辅助运动区。另一方面，对主要依赖于涉及脑干和脊髓的神经元回路的外部干扰的反应性姿势控制，受 SCS 的影响较小。
