Brugger Florian, Wegener Regina, Baty Florent, Walch Julia, Krüger Marie T, Hägele-Link Stefan, Bohlhalter Stephan, Kägi Georg
Department of Neurology, Kantonsspital St. Gallen, CH-9007 St. Gallen, Switzerland.
Laboratory for Motion Analysis, Department of Paediatric Orthopaedics, Children's Hospital of Eastern Switzerland, CH-9007 St. Gallen, Switzerland.
Brain Sci. 2021 Mar 3;11(3):321. doi: 10.3390/brainsci11030321.
Freezing of gait (FOG) in Parkinson's disease (PD) occurs frequently in situations with high environmental complexity. The supplementary motor cortex (SMC) is regarded as a major network node that exerts cortical input for motor control in these situations. We aimed at assessing the impact of single-session (excitatory) intermittent theta burst stimulation (iTBS) of the SMC on established walking during FOG provoking situations such as passing through narrow spaces and turning for directional changes. Twelve PD patients with FOG underwent two visits in the off-medication state with either iTBS or sham stimulation. At each visit, spatiotemporal gait parameters were measured during walking without obstacles and in FOG-provoking situations before and after stimulation. When patients passed through narrow spaces, decreased stride time along with increased stride length and walking speed (i.e., improved gait) was observed after both sham stimulation and iTBS. These effects, particularly on stride time, were attenuated by real iTBS. During turning, iTBS resulted in decreased stride time along with unchanged stride length, a constellation compatible with increased stepping frequency. The observed iTBS effects are regarded as relative gait deterioration. We conclude that iTBS over the SMC increases stepping frequency in PD patients with FOG, particularly in FOG provoking situations.
帕金森病（PD）中的冻结步态（FOG）在环境复杂性高的情况下频繁出现。辅助运动皮层（SMC）被视为在这些情况下对运动控制施加皮层输入的主要网络节点。我们旨在评估单次（兴奋性）间歇性theta爆发刺激（iTBS）对SMC在FOG诱发情况下（如穿过狭窄空间和转弯以改变方向）的既定步行的影响。12名患有FOG的PD患者在未服药状态下接受了两次就诊，分别接受iTBS或假刺激。每次就诊时，在无障碍物行走以及刺激前后的FOG诱发情况下测量时空步态参数。当患者穿过狭窄空间时，在假刺激和iTBS后均观察到步幅时间减少，同时步幅长度和步行速度增加（即步态改善）。这些效应，尤其是对步幅时间的影响，在真正接受iTBS时减弱。在转弯过程中，iTBS导致步幅时间减少，步幅长度不变，这一组合与步频增加相符。观察到的iTBS效应被视为相对步态恶化。我们得出结论，对SMC进行iTBS可增加患有FOG的PD患者的步频，尤其是在FOG诱发情况下。
