Lou Ruvo Center for Brain Health, Cleveland Clinic, 888 W Bonneville Ave, Las Vegas, NV, 89106, USA; Stanford University, Department of Neurology and Neurosciences, 213 Quarry Road, Palo Alto, CA, 94035, USA.
Lou Ruvo Center for Brain Health, Cleveland Clinic, 888 W Bonneville Ave, Las Vegas, NV, 89106, USA.
Parkinsonism Relat Disord. 2019 Apr;61:26-33. doi: 10.1016/j.parkreldis.2018.11.013. Epub 2018 Nov 15.
Freezing of gait is an episodic inability to move the feet forward despite the intention to walk. It is a common cause of falls and subsequent morbidity and mortality in Parkinson's disease. Virtual reality paradigms provide an opportunity to safely evaluate freezing of gait, in order to better understand the underlying pathophysiology. This article focuses on the methodology, threshold used to define freezing of gait, results, limitations of studies using virtual reality paradigms, and proposes future directions of research. Summarizing these articles improves our understanding of freezing of gait in Parkinson's disease, and critical evaluation provides an opportunity for future studies to improve upon these efforts.
We performed a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines, of studies using VR paradigms to elucidate the underlying pathophysiology of PD-FOG.
This review initially identified 57 articles, but after exclusion of duplicates, abstracts, and studies not focused on the underlying pathophysiology of this disorder, 12 peer-reviewed articles using virtual reality paradigms to evaluate freezing of gait in Parkinson's disease were found.
Virtual reality paradigms are able to reproduce freezing of gait. Studies using MRI compatible virtual reality to evaluate freezing of gait found dysfunctional connectivity between cortical and subcortical structures during episodes. However, several important limitations of these studies should caution our interpretation of these results. Future studies which improve the design and methodology are needed to ultimately identify the cause and subsequent treatments for freezing of gait in Parkinson's disease.
冻结步态是一种阵发性的无法向前移动脚部的能力，尽管有行走的意图。它是帕金森病患者跌倒和随后发病率和死亡率的常见原因。虚拟现实范式提供了一个安全评估冻结步态的机会，以便更好地了解潜在的病理生理学。本文重点介绍了使用虚拟现实范式的方法学、定义冻结步态的阈值、结果、研究的局限性，并提出了未来的研究方向。总结这些文章提高了我们对帕金森病冻结步态的理解，而批判性评估为未来的研究提供了改进这些努力的机会。
我们按照系统评价和荟萃分析的首选报告项目 (PRISMA) 声明指南，对使用 VR 范式阐明 PD-FOG 潜在病理生理学的研究进行了系统回顾。
本综述最初确定了 57 篇文章，但在排除重复、摘要和未关注该疾病潜在病理生理学的研究后，发现了 12 篇使用虚拟现实范式评估帕金森病冻结步态的同行评议文章。
虚拟现实范式能够再现冻结步态。使用与 MRI 兼容的虚拟现实评估冻结步态的研究发现，在发作期间皮质和皮质下结构之间存在功能连接障碍。然而，这些研究的几个重要局限性应该引起我们对这些结果的解释的警惕。需要改进设计和方法学的未来研究，最终确定帕金森病冻结步态的原因和随后的治疗方法。
