Department of Neurology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China.
Mov Disord. 2023 Nov;38(11):2072-2083. doi: 10.1002/mds.29595. Epub 2023 Aug 30.
Dysfunction of the primary motor cortex, participating in regulation of posture and gait, is implicated in freezing of gait (FOG) in Parkinson's disease (PD).
The aim was to reveal the mechanisms of "OFF-period" FOG (OFF-FOG) and "levodopa-unresponsive" FOG (ONOFF-FOG) in PD.
We measured the transcranial magnetic stimulation (TMS) indicators and gait parameters in 21 healthy controls (HCs), 15 PD patients with ONOFF-FOG, 15 PD patients with OFF-FOG, and 15 PD patients without FOG (Non-FOG) in "ON" and "OFF" medication conditions. Difference of TMS indicators in the four groups and two conditions and its correlations with gait parameters were explored. Additionally, we explored the effect of 10 Hz repetitive TMS on gait and TMS indicators in ONOFF-FOG patients.
In "OFF" condition, short interval intracortical inhibition (SICI) exhibited remarkable attenuation in FOG patients (both ONOFF-FOG and OFF-FOG) compared to Non-FOG patients and HCs. The weakening of SICI correlated with impaired gait characteristics in FOG. However, in "ON" condition, SICI in ONOFF-FOG patients reduced compared to OFF-FOG patients. Pharmacological treatment significantly improved SICI and gait in OFF-FOG patients, and high-frequency repetitive TMS distinctly improved gait in ONOFF-FOG patients, accompanied by enhanced SICI.
Motor cortex disinhibition, represented by decreased SICI, is related to FOG in PD. Refractory freezing in ONOFF-FOG patients correlated with the their reduced SICI insensitive to dopaminergic medication. SICI can serve as an indicator of the severity of impaired gait characteristics in FOG and reflect treatments efficacy for FOG in PD patients. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
初级运动皮层功能障碍参与姿势和步态的调节，与帕金森病（PD）中的冻结步态（FOG）有关。
旨在揭示 PD 中“关期”FOG（OFF-FOG）和“左旋多巴无反应”FOG（ONOFF-FOG）的机制。
我们在“开”和“关”药物条件下测量了 21 名健康对照者（HCs）、15 名 ONOFF-FOG 患者、15 名 OFF-FOG 患者和 15 名无 FOG（Non-FOG）患者的经颅磁刺激（TMS）指标和步态参数。探讨了四组和两种状态下 TMS 指标的差异及其与步态参数的相关性。此外，我们还探讨了 10 Hz 重复 TMS 对 ONOFF-FOG 患者步态和 TMS 指标的影响。
在“关”期，FOG 患者（ONOFF-FOG 和 OFF-FOG 患者）的短程皮质内抑制（SICI）明显减弱，与 Non-FOG 患者和 HCs 相比。SICI 的减弱与 FOG 中步态特征的受损相关。然而，在“开”期，ONOFF-FOG 患者的 SICI 较 OFF-FOG 患者减少。药物治疗显著改善了 OFF-FOG 患者的 SICI 和步态，高频重复 TMS 明显改善了 ONOFF-FOG 患者的步态，同时增强了 SICI。
以 SICI 降低为代表的运动皮层去抑制与 PD 中的 FOG 有关。ONOFF-FOG 患者的难治性冻结与他们对多巴胺能药物治疗不敏感的降低 SICI 有关。SICI 可作为 FOG 中步态特征受损严重程度的指标，并反映 PD 患者 FOG 的治疗效果。
