Doorway-provoked freezing of gait in Parkinson's disease
Doorway-provoked freezing of gait in Parkinson's disease
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DOI：
10.1002/mds.23990
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发表时间：
2012-04-01
影响因子：
8.6
通讯作者：
Day, Brian L.
中科院分区：
文献类型：
--
作者：
Cowie, Dorothy;Limousin, Patricia;Day, Brian L.
帕金森氏症患者的步态冻结很难在实验室进行研究。在这里，我们调查了使用可变宽度的门口来激发冻结行为，以及新的客观方法来测量它。通过这种方法，我们比较了抗帕金森病治疗(药物和丘脑底核深部刺激)对冰冻和其他步态损伤的影响。研究对象为10名冰柜和10名对照组参与者。在4种门道状态(无门，门宽为肩宽的100%、125%和150%)和4种处理状态(Offmeds/Offstim、Offmeds/Onstim、Onmeds/Offstim、Onmeds/onstim)中的每一种情况下，受试者以较佳的速度行走时测量全身运动学。在没有门口的情况下，帕金森氏症患者表现出特有的步态障碍，包括速度慢、步幅小和步数不定。治疗改善了这些干扰。帕金森氏症组在门口的速度进一步减慢，减速幅度与门宽成反比，这表明视觉运动障碍。仅靠任何一种治疗都不能改善这一点。最后，成功地在门口附近引发了冰冻样事件，在较窄的门口，这种事件的患病率显著增加。这些都是在临床上定义的，并由2个与临床分级相关的客观标准来定义。冻结样事件的风险可以通过药物降低，但不是通过脑深部刺激。冻结行为可以在可复制的实验环境中使用可变宽度的门口范例来激发，并使用这里介绍的两种定义进行客观测量。药物和脑深部刺激对步态障碍的不同影响突出了帕金森病步态障碍及其治疗的复杂性。(C)2011年运动无序社
Freezing of gait in Parkinson's disease can be difficult to study in the laboratory. Here we investigate the use of a variable-width doorway to provoke freeze behavior together with new objective methods to measure it. With this approach we compare the effects of anti-parkinsonian treatments (medications and deep-brain stimulation of the subthalamic nucleus) on freezing and other gait impairments. Ten freezers and 10 control participants were studied. Whole-body kinematics were measured while participants walked at preferred speed in each of 4 doorway conditions (no door present, door width at 100%, 125%, and 150% of shoulder width) and in 4 treatment states (offmeds/offstim, offmeds/onstim, onmeds/offstim, onmeds/onstim). With no doorway, the Parkinson's group showed characteristic gait disturbances including slow speed, short steps, and variable step timing. Treatments improved these disturbances. The Parkinson's group slowed further at doorways by an amount inversely proportional to door width, suggesting a visuomotor dysfunction. This was not improved by either treatment alone. Finally, freeze-like events were successfully provoked near the doorway and their prevalence significantly increased in narrower doorways. These were defined clinically and by 2 objective criteria that correlated well with clinical ratings. The risk of freeze-like events was reduced by medication but not by deep-brain stimulation. Freeze behavior can be provoked in a replicable experimental setting using the variable-width doorway paradigm, and measured objectively using 2 definitions introduced here. The differential effects of medication and deep-brain stimulation on the gait disturbances highlight the complexity of Parkinsonian gait disorders and their management. (c) 2011 Movement Disorder Society