Rahimpour Shervin, Gaztanaga Wendy, Yadav Amol P, Chang Stephano J, Krucoff Max O, Cajigas Iahn, Turner Dennis A, Wang Doris D
Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA.
Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, FL, USA.
Neuromodulation. 2021 Jul;24(5):829-842. doi: 10.1111/ner.13347. Epub 2020 Dec 26.
Freezing of gait (FoG) is one of the most disabling yet poorly understood symptoms of Parkinson's disease (PD). FoG is an episodic gait pattern characterized by the inability to step that occurs on initiation or turning while walking, particularly with perception of tight surroundings. This phenomenon impairs balance, increases falls, and reduces the quality of life.
Clinical-anatomical correlations, electrophysiology, and functional imaging have generated several mechanistic hypotheses, ranging from the most distal (abnormal central pattern generators of the spinal cord) to the most proximal (frontal executive dysfunction). Here, we review the neuroanatomy and pathophysiology of gait initiation in the context of FoG, and we discuss targets of central nervous system neuromodulation and their outcomes so far. The PubMed database was searched using these key words: neuromodulation, freezing of gait, Parkinson's disease, and gait disorders.
Despite these investigations, the pathogenesis of this process remains poorly understood. The evidence presented in this review suggests FoG to be a heterogenous phenomenon without a single unifying pathologic target. Future studies rigorously assessing targets as well as multimodal approaches will be essential to define the next generation of therapeutic treatments.
冻结步态（FoG）是帕金森病（PD）最具致残性但却了解甚少的症状之一。冻结步态是一种发作性步态模式，其特征为在行走起始或转弯时，尤其是在感觉周围空间狭窄时无法迈步。这种现象会损害平衡、增加跌倒风险并降低生活质量。
临床解剖学关联、电生理学和功能成像已产生了几种机制假说，范围从最远端（脊髓异常的中枢模式发生器）到最近端（额叶执行功能障碍）。在此，我们在冻结步态的背景下回顾步态起始的神经解剖学和病理生理学，并讨论中枢神经系统神经调节的靶点及其目前的结果。使用以下关键词检索了PubMed数据库：神经调节、冻结步态、帕金森病和步态障碍。
尽管进行了这些研究，但该过程的发病机制仍了解甚少。本综述中提出的证据表明，冻结步态是一种异质性现象，没有单一统一的病理靶点。未来严格评估靶点以及多模式方法的研究对于确定下一代治疗方法至关重要。
