• Deep brain stimulation
• Parkinson’s disease
• field H1 of Forel
• quality of life
• stereotactic neurosurgery

• Humans
• Parkinson Disease/therapy
• Parkinson Disease/psychology
• Parkinson Disease/physiopathology
• Parkinson Disease/complications
• Subthalamic Nucleus/physiology
• Deep Brain Stimulation/methods
• Male
• Female
• Quality of Life/psychology
• Aged
• Middle Aged
• Treatment Outcome
• Follow-Up Studies
• Gait Disorders, Neurologic/therapy
• Gait Disorders, Neurologic/etiology

• complimentary and integrative health
• movement coordination
• muscle tone
• musculoskeletal pain
• neurophysiology
• postural tone
• stiffness

• Parkinson's disease
• deep brain stimulation
• freezing of gait
• substantia nigra
• subthalamic nucleus

• Humans
• Parkinson Disease/therapy
• Parkinson Disease/complications
• Parkinson Disease/physiopathology
• Deep Brain Stimulation/methods
• Male
• Subthalamic Nucleus
• Female
• Pilot Projects
• Gait Disorders, Neurologic/etiology
• Gait Disorders, Neurologic/therapy
• Gait Disorders, Neurologic/physiopathology
• Middle Aged
• Aged
• Double-Blind Method
• Cross-Over Studies
• Substantia Nigra/physiopathology

• Parkinson’s disease
• adaptive deep brain stimulation
• gait
• local field potentials
• subthalamic nucleus

• Deep brain stimulation
• Freezing of gait
• Gait disorders
• Parkinson´s disease
• Postural instability
• Subthalamic nucleus

• Humans
• Deep Brain Stimulation/methods
• Gait Disorders, Neurologic/etiology
• Gait Disorders, Neurologic/physiopathology
• Gait Disorders, Neurologic/therapy
• Parkinson Disease/therapy
• Parkinson Disease/complications
• Subthalamic Nucleus/physiopathology
• Treatment Outcome

• Parkinson’s disease
• Tinetti balance and gait score
• Unified Parkinson’s Disease Rating Scale
• anticipatory postural adjustments
• center of pressure trajectories
• fall risk

• Bayes factor 01
• Bland–Altman
• Parkinson’s disease
• biomechanics
• force plate
• gait initiation
• healthy adults
• margin of stability
• markerless motion capture

• Humans
• Parkinson Disease/physiopathology
• Gait/physiology
• Aged
• Postural Balance/physiology
• Male
• Female
• Adult
• Middle Aged
• Young Adult
• Biomechanical Phenomena/physiology
• Motion Capture

• CIFRE N◦2020/1053 Agence national de la recherche et technologie

• R01 EB033790 NIBIB NIH HHS
• S10 OD026796 NIH HHS
• RF1 MH117053 NIMH NIH HHS
• R01 NS091236 NINDS NIH HHS
• R01 MH126518 NIMH NIH HHS
• S10 MH124745 NIMH NIH HHS
• R01 MH111429 NIMH NIH HHS

• Bayes factor 01
• Bland and Altman
• Parkinson’s disease
• biomechanics
• braking index
• force-plate
• gait initiation
• healthy adults
• markerless motion capture
• motor performance

• Adult
• Humans
• Aged
• Parkinson Disease
• Motion Capture
• Bayes Theorem
• Biomechanical Phenomena
• Gait

• CIFRE N°2020/1053 Association Nationale de la Recherche et de la Technologie

• Deep brain stimulation (DBS)
• Parkinson’s disease
• gait analysis
• substantia nigra

• Humans
• Biomechanical Phenomena
• Deep Brain Stimulation
• Gait
• Leg
• Parkinson Disease/therapy
• Cross-Over Studies
• Double-Blind Method

• Parkinson’s disease
• adaptive
• beta
• closed loop
• deep brain stimulation
• globus pallidus internus (GPi)
• subthalamic nucleus (STN)

• UG3 NS128150 NINDS NIH HHS
• UH3 NS107709 NINDS NIH HHS
• National Institute of Neurological Disorders and Stroke

• CP: Neuroscience
• GABAergic neurons
• NALCN channels
• Parkinson's disease
• basal ganglia
• intrinsic excitability
• motor behavior
• parvalbumin

• Mice
• Animals
• Pars Reticulata
• Substantia Nigra
• Parvalbumins
• Neurons/physiology
• Parkinson Disease

• Parkinson’s disease
• anticipatory postural adjustments
• compensatory postural responses
• deep brain stimulation
• motor control
• multidirectional perturbations
• postural instability
• subthalamic nucleus

• 491193532 Chemnitz University of Technology
• 491193532 Deutsche Forschungsgemeinschaft

• geriatric medicine
• health & safety
• parkinson-s disease

• Humans
• Parkinson Disease/complications
• Gait
• Exercise
• Qigong/methods
• Walking

• Parkinson’s disease
• deep brain stimulation
• functional neuroanatomy
• neurosurgery
• new targets
• new technologies
• subthalamic nucleus

• Deep Brain Stimulation/adverse effects
• Deep Brain Stimulation/methods
• Globus Pallidus
• Humans
• Neurodegenerative Diseases/etiology
• Parkinson Disease
• Subthalamic Nucleus

• Parkinson’s disease
• deep brain stimulation (DBS)
• freezing of gait (FOG)
• globus pallidus pars interna (GPi)
• pedunculopontine nucleus (PPN)
• subthalamic nucleus (STN)

• Parkinson’s disease
• deep brain stimulation
• gait
• substantia nigra
• subthalamic nucleus

• parkinson's disease

• MR/T023880/1 Medical Research Council

• body center of mass
• braking index
• dynamic balance
• kinematics
• kinetics

Background: Although a variety of targets for deep brain stimulation (DBS) have been found to be effective in Parkinson's disease (PD), it remains unclear which target for DBS leads to the best improvement in gait disorders in patients with PD. The purpose of this network meta-analysis (NMA) is to compare the efficacy of subthalamic nucleus (STN)-DBS, internal globus pallidus (GPi)-DBS, and pedunculopontine nucleus (PPN)-DBS, in improving gait disorders in patients with PD.

Methods: We searched the PubMed database for articles published from January 1990 to December 2020. We used various languages to search for relevant documents to reduce language bias. A Bayesian NMA and systematic review of randomized and non-randomized controlled trials were conducted to explore the effects of different targets for DBS on gait damage.

Result: In the 34 included studies, 538 patients with PD met the inclusion criteria. The NMA results of the effect of the DBS “on and off” on the mean change of the gait of the patients in medication-off show that GPi-DBS, STN-DBS, and PPN-DBS are significantly better than the baseline [GPi-DBS: –0.79(–1.2, –0.41), STN-DBS: –0.97(–1.1, –0.81), and PPN-DBS: –0.56(–1.1, –0.021)]. According to the surface under the cumulative ranking (SUCRA) score, the STN-DBS (SUCRA = 74.15%) ranked first, followed by the GPi-DBS (SUCRA = 48.30%), and the PPN-DBS (SUCRA = 27.20%) ranked last. The NMA results of the effect of the DBS “on and off” on the mean change of the gait of the patients in medication-on show that, compared with baseline, GPi-DBS and STN-DBS proved to be significantly effective [GPi-DBS: –0.53 (–1.0, –0.088) and STN-DBS: –0.47(–0.66, –0.29)]. The GPi-DBS ranked first (SUCRA = 59.00%), followed by STN-DBS(SUCRA = 51.70%), and PPN-DBS(SUCRA = 35.93%) ranked last.

Conclusion: The meta-analysis results show that both the STN-DBS and GPi-DBS can affect certain aspects of PD gait disorder.

• Bayesian network meta-analysis
• Parkinson's disease
• deep brain stimulation
• gait
• motor symptoms

• Parkinson’s disease
• deep brain stimulation
• movement disorders
• neurosurgery
• transcranial magnetic stimulation

• deep brain stimulation
• extinction
• methamphetamine
• relapse
• substantia nigra pars reticulata

• Parkinson’s disease
• freezing of gait (FoG)
• genetics
• neurophysiology
• stimulation

The Substantia Nigra pars reticulata (SNr) is a promising target for deep brain stimulation (DBS) to treat the gait and postural disturbances in Parkinson’s disease (PD). Positioning the DBS electrode within the SNr is critical for the development of preclinical models of SNr DBS to investigate underlying mechanisms. However, a complete characterization of intraoperative microelectrode recordings in the SNr to guide DBS electrode placement is lacking. In this study, we recorded extracellular single-unit activity in anesthetized rats at multiple locations in the medial SNr (mSNr), lateral SNr (lSNr), and the Ventral Tegmental Area (VTA). Immunohistochemistry and fluorescently dyed electrodes were used to map neural recordings to neuroanatomy. Neural recordings were analyzed in the time domain (i.e., firing rate, interspike interval (ISI) correlation, ISI variance, regularity, spike amplitude, signal-to-noise ratio, half-width, asymmetry, and latency) and the frequency domain (i.e., spectral power in frequency bands of interest). Spike amplitude decreased and ISI correlation increased in the mSNr versus the lSNr. Spike amplitude, signal-to-noise ratio, and ISI correlation increased in the VTA versus the mSNr. ISI correlation increased in the VTA versus the lSNr. Spectral power in the VTA increased versus: (1) the mSNr in the 20–30 Hz band and (2) the lSNr in the 20–40 Hz band. No significant differences were observed between structures for any other feature analyzed. Our results shed light on the heterogeneity of the SNr and suggest electrophysiological features to promote precise targeting of SNr subregions during stereotaxic surgery.

• Parkinson’s disease
• Substantia Nigra pars reticulata
• action potentials
• deep brain stimulation
• intraoperative microelectrode recordings

• Basal ganglia
• Dysfunction
• Parkinson's disease
• Pathophysiology
• Retina
• Superior colliculus

• ADHD
• GAITrite®
• Gait
• Motor skills
• Rehabilitation

• Dementia with Lewy bodies
• Falls
• Management
• Multiple system atrophy
• Parkinson’s disease
• Prevention
• Risk

• Cognition
• Parkinson’s disease
• cueing
• exercise
• falls
• frailty
• freezing of gait
• neurostimulation
• pharmacotherapy
• physical therapy

Introduction: The progressive modular rebalancing (PMR) system is a comprehensive rehabilitation approach derived from proprioceptive neuromuscular facilitation principles. PMR training encourages focus on trunk and proximal muscle function through direct perception, strength, and stretching exercises and emphasizes bi-articular muscle function in the improvement of gait performance. Sensory cueing, such as visual cues (VC), is one of the more established techniques for gait rehabilitation in PD. In this study, we propose PMR combined with VC for improving gait performance, balance, and trunk control during gait in patients with PD. Our assumption herein was that the effect of VC may add to improved motor performance induced by the PMR treatment. The primary aim of this study was to evaluate whether the PMR system plus VC was a more effective treatment option than standard physiotherapy in improving gait function in patients with PD. The secondary aim of the study was to evaluate the effect of this treatment on motor function severity.

Design: Two-center, randomized, controlled, observer-blind, crossover study with a 4-month washout period.

Participants: Forty individuals with idiopathic PD in Hoehn and Yahr stages 1–4.

Intervention: Eight-week rehabilitation programs consisting of PMR plus VC (treatment A) and conventional physiotherapy (treatment B).

Primary outcome measures: Spatiotemporal gait parameters, joint kinematics, and trunk kinematics.

Secondary outcome measures: UPDRS-III scale scores.

Results: The rehabilitation program was well-tolerated by individuals with PD and most participants showed improvements in gait variables and UPDRS-III scores with both treatments. However, patients who received PMR with VC showed better results in gait function with regard to gait performance (increased step length, gait speed, and joint kinematics), gait balance (increased step width and double support duration), and trunk control (increased trunk motion) than those receiving conventional physiotherapy. While crossover results revealed some differences in primary outcomes, only 37.5% of patients crossed over between the groups. As a result, our findings should be interpreted cautiously.

Conclusions: The PMR plus VC program could be used to improve gait function and severity motor of motor deficit in individuals with PD.

Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT03346265.

• Parkinson's disease
• gait analysis
• neurorehabilitation
• progressive modular rebalancing system
• sensory cues

• Accidental Falls
• Adult
• Aged
• Aged, 80 and over
• Biomechanical Phenomena/physiology
• Female
• Gait/physiology
• Humans
• Male
• Postural Balance/physiology
• Risk Assessment
• Risk Factors
• Walking/physiology
• Young Adult

• Parkinson’s disease
• functional neurosurgery
• hands and feet motor control
• movement pace
• neuronal recruitment
• single-unit recording
• subthalamic nucleus

Deep brain stimulation (DBS) has become the treatment of choice for advanced stages of Parkinson's disease, medically intractable essential tremor, and complicated segmental and generalized dystonia. In addition to accurate electrode placement in the target area, effective programming of DBS devices is considered the most important factor for the individual outcome after DBS. Programming of the implanted pulse generator (IPG) is the only modifiable factor once DBS leads have been implanted and it becomes even more relevant in cases in which the electrodes are located at the border of the intended target structure and when side effects become challenging. At present, adjusting stimulation parameters depends to a large extent on personal experience. Based on a comprehensive literature search, we here summarize previous studies that examined the significance of distinct stimulation strategies for ameliorating disease signs and symptoms. We assess the effect of adjusting the stimulus amplitude (A), frequency (f), and pulse width (pw) on clinical symptoms and examine more recent techniques for modulating neuronal elements by electrical stimulation, such as interleaving (Medtronic®) or directional current steering (Boston Scientific®, Abbott®). We thus provide an evidence-based strategy for achieving the best clinical effect with different disorders and avoiding adverse effects in DBS of the subthalamic nucleus (STN), the ventro-intermedius nucleus (VIM), and the globus pallidus internus (GPi).

• DBS programming algorithms
• DBS side effects
• segmented electrode
• short pulse width
• subthalamic nucleus

Deep brain stimulation of the subthalamic nucleus is an effective treatment for Parkinson’s disease symptoms. The therapeutic benefits of deep brain stimulation are frequency-dependent, but the underlying physiological mechanisms remain unclear. To advance deep brain stimulation therapy an understanding of fundamental mechanisms is critical. The objectives of this study were to (i) compare the frequency-dependent effects on cell firing in subthalamic nucleus and substantia nigra pars reticulata; (ii) quantify frequency-dependent effects on short-term plasticity in substantia nigra pars reticulata; and (iii) investigate effects of continuous long-train high frequency stimulation (comparable to conventional deep brain stimulation) on synaptic plasticity. Two closely spaced (600 µm) microelectrodes were advanced into the subthalamic nucleus (n = 27) and substantia nigra pars reticulata (n = 14) of 22 patients undergoing deep brain stimulation surgery for Parkinson’s disease. Cell firing and evoked field potentials were recorded with one microelectrode during stimulation trains from the adjacent microelectrode across a range of frequencies (1–100 Hz, 100 µA, 0.3 ms, 50–60 pulses). Subthalamic firing attenuated with ≥20 Hz (P < 0.01) stimulation (silenced at 100 Hz), while substantia nigra pars reticulata decreased with ≥3 Hz (P < 0.05) (silenced at 50 Hz). Substantia nigra pars reticulata also exhibited a more prominent increase in transient silent period following stimulation. Patients with longer silent periods after 100 Hz stimulation in the subthalamic nucleus tended to have better clinical outcome after deep brain stimulation. At ≥30 Hz the first evoked field potential of the stimulation train in substantia nigra pars reticulata was potentiated (P < 0.05); however, the average amplitude of the subsequent potentials was rapidly attenuated (P < 0.01). This is suggestive of synaptic facilitation followed by rapid depression. Paired pulse ratios calculated at the beginning of the train revealed that 20 Hz (P < 0.05) was the minimum frequency required to induce synaptic depression. Lastly, the average amplitude of evoked field potentials during 1 Hz pulses showed significant inhibitory synaptic potentiation after long-train high frequency stimulation (P < 0.001) and these increases were coupled with increased durations of neuronal inhibition (P < 0.01). The subthalamic nucleus exhibited a higher frequency threshold for stimulation-induced inhibition than the substantia nigra pars reticulata likely due to differing ratios of GABA:glutamate terminals on the soma and/or the nature of their GABAergic inputs (pallidal versus striatal). We suggest that enhancement of inhibitory synaptic plasticity, and frequency-dependent potentiation and depression are putative mechanisms of deep brain stimulation. Furthermore, we foresee that future closed-loop deep brain stimulation systems (with more frequent off stimulation periods) may benefit from inhibitory synaptic potentiation that occurs after high frequency stimulation.

• Parkinson’s disease
• clinical neurophysiology
• deep brain stimulation
• neurosurgery
• subthalamic nucleus

• Deep brain stimulation
• Falls
• Freezing of gait
• Parkinson's disease
• Subthalamic nucleus

• Freezing of gait
• Parkinson's disease
• Substantia nigra
• Subthalamic nucleus

• Deep Brain Stimulation
• Gait
• Gait Disorders, Neurologic
• Humans
• Levodopa
• Parkinson Disease
• Pars Reticulata
• Pilot Projects
• Substantia Nigra
• Subthalamic Nucleus

• Freezing of gait
• Parkinson’s disease
• Postural control
• Posturography

Several patients with Parkinson´s disease (PD) can walk normally along straight trajectories, and impairment in their stride length and cadence may not be easily discernible. Do obvious abnormalities occur in these high-functioning patients when more challenging trajectories are travelled, such as circular paths, which normally implicate a graded modulation in the duration of the interlimb gait cycle phases?

We compared a cohort of well-treated mildly to moderately affected PD patients to a group of age-matched healthy subjects (HS), by deliberately including HS spontaneously walking at the same speed of the patients with PD. All participants performed, in random order: linear and circular walking (clockwise and counter-clockwise) at self-selected speed. By means of pressure-sensitive insoles, we recorded walking speed, cadence, duration of single support, double support, swing phase, and stride time. Stride length-cadence relationships were built for linear and curved walking. Stride-to-stride variability of temporal gait parameters was also estimated.

Walking speed, cadence or stride length were not different between PD and HS during linear walking. Speed, cadence and stride length diminished during curved walking in both groups, stride length more in PD than HS. In PD compared to HS, the stride length-cadence relationship was altered during curved walking. Duration of the double-support phase was also increased during curved walking, as was variability of the single support, swing phase and double support phase.

The spatio-temporal gait pattern and variability are significantly modified in well-treated, high-functioning patients with PD walking along circular trajectories, even when they exhibit no changes in speed in straight-line walking. The increased variability of the gait phases during curved walking is an identifying characteristic of PD. We discuss our findings in term of interplay between control of balance and of locomotor progression: the former is challenged by curved trajectories even in high-functioning patients, while the latter may not be critically affected.

• Aged
• Biomechanical Phenomena
• Female
• Gait/physiology
• Gait Disorders, Neurologic/physiopathology
• Humans
• Male
• Parkinson Disease/physiopathology
• Postural Balance

• Italian Ministry of Health
• Italian Ministry of University and Research

• Advanced Parkinson’s disease
• Balance
• Gait
• Medical management
• Physical activity
• Posture

• Aged
• Gait/physiology
• Humans
• Male
• Parkinson Disease/physiopathology
• Parkinson Disease/therapy
• Postural Balance/physiology
• Posture/physiology
• Quality of Life

• Aged
• Aged, 80 and over
• Exercise Therapy/methods
• Female
• Gait/physiology
• Gait Disorders, Neurologic/diagnosis
• Gait Disorders, Neurologic/physiopathology
• Gait Disorders, Neurologic/rehabilitation
• Humans
• Locomotion/physiology
• Male
• Middle Aged
• Parkinson Disease/diagnosis
• Parkinson Disease/physiopathology
• Parkinson Disease/rehabilitation
• Postural Balance/physiology

• Adult
• Biomechanical Phenomena
• Female
• Gait/physiology
• Humans
• Knee Joint/physiology
• Male
• Orthotic Devices
• Posture
• Young Adult