Effects of non-invasive brain stimulation on freezing of gait in parkinsonism: A systematic review with meta-analysis

Kim, Yong Wook; Shin, In-Soo; Moon, Hyun Im; Lee, Sang Chul; Yoon, Seo Yeon

doi:10.1016/j.parkreldis.2019.02.029

Cited by 35 publications

(31 citation statements)

References 28 publications

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“…Results showed that rTMS had a beneficial effect on FOG in PD patients assessed by FOGQ and turning time. However, subgroup analysis according to stimulation site showed neither motor cortex stimulation nor frontal cortex stimulation had beneficial effect on FOG [153]. Other stimulation site has also been explored.…”

Section: Transcranial Magnetic Stimulation (Tms)mentioning

confidence: 99%

Freezing of gait in Parkinson’s disease: pathophysiology, risk factors and treatments

Gao

Tan

et al. 2020

Transl Neurodegener

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Background: Freezing of gait (FOG) is a common, disabling symptom of Parkinson's disease (PD), but the mechanisms and treatments of FOG remain great challenges for clinicians and researchers. The main focus of this review is to summarize the possible mechanisms underlying FOG, the risk factors for screening and predicting the onset of FOG, and the clinical trials involving various therapeutic strategies. In addition, the limitations and recommendations for future research design are also discussed. Main body: In the mechanism section, we briefly introduced the physiological process of gait control and hypotheses about the mechanism of FOG. In the risk factor section, gait disorders, PIGD phenotype, lower striatal DAT uptake were found to be independent risk factors of FOG with consistent evidence. In the treatment section, we summarized the clinical trials of pharmacological and non-pharmacological treatments. Despite the limited effectiveness of current medications for FOG, especially levodopa resistant FOG, there were some drugs that showed promise such as istradefylline and rasagiline. Non-pharmacological treatments encompass invasive brain and spinal cord stimulation, noninvasive repetitive transcranial magnetic stimulation (rTMS) or transcranial direct current stimulation (tDCS) and vagus nerve stimulation (VNS), and physiotherapeutic approaches including cues and other training strategies. Several novel therapeutic strategies seem to be effective, such as rTMS over supplementary motor area (SMA), dual-site DBS, spinal cord stimulation (SCS) and VNS. Of physiotherapy, wearable cueing devices seem to be generally effective and promising.Conclusion: FOG model hypotheses are helpful for better understanding and characterizing FOG and they provide clues for further research exploration. Several risk factors of FOG have been identified, but need combinatorial optimization for predicting FOG more precisely. Although firm conclusions cannot be drawn on therapeutic efficacy, the literature suggested that some therapeutic strategies showed promise.

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Section: Transcranial Magnetic Stimulation (Tms)mentioning

confidence: 99%

Freezing of gait in Parkinson’s disease: pathophysiology, risk factors and treatments

Gao

Tan

et al. 2020

Transl Neurodegener

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“…Inclusion criteria for study selection were: (1) randomized controlled trials (RCTs; parallel or crossover design) and (2) feasibility and pilot RCT studies, that assess the effectiveness of physiotherapy intervention compared to other intervention or no intervention on FOG symptoms in subjects with idiopathic PD; and (3) provided the FOG questionnaire (FOG-Q) 24,25 or new FOG (nFOG-Q) questionnaire 28 data, available in the article or upon request. Exclusion criteria were: (1) single-session interventions, (2) nonphysiotherapy interventions (e.g., dance, tai-chi), (3) noninvasive brain stimulation or the use of external devices not associated with physiotherapy, and (4) abstract and conference proceedings.…”

Section: Eligibility Criteriamentioning

confidence: 99%

“…(3) provided the FOG questionnaire (FOG-Q) 24,25 or new FOG (nFOG-Q) questionnaire 28 data, available in the article or upon request. Exclusion criteria were:…”

Section: Eligibility Criteriamentioning

confidence: 99%

Effectiveness of Physiotherapy on Freezing of Gait in Parkinson's Disease: A Systematic Review and Meta‐Analyses

et al. 2019

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A BS TRACT: Freezing of gait is considered one of the most disabling gait disorders in patients with PD. An effective treatment for freezing of gait is missing, thus current management requires a multidisciplinary approach. Among treatment options, physiotherapy is acknowledged to be crucial; however, a systematic review that demonstrates its efficacy is missing. This review aims at examining the short-and long-term effects of physiotherapy in improving freezing of gait in PD patients. Five electronic databases were searched for English-language full-text articles, and only randomized controlled trials were considered. The freezing of gait questionnaire was selected as the primary outcome measure because it is the only validated measure used to evaluate the severity and impact of freezing of gait on patients' daily life. From 1,130 trials, 19 relevant studies, including 913 patients, were selected. The included studies varied for sample size, methodology, and type of intervention. None of the studies had a low risk of bias, but the majority of randomized control trials presented a low risk for at least 6 of 13 biases. Our findings provide evidence for short-term effectiveness of physiotherapy in improving freezing of gait (physiotherapy vs. no treatment: effect size = -0.28 [-0.45, -0.11], P = 0.001; physiotherapy vs. control: effect size = 0.43 [-0.65, -0.21], P < 0.0001), particularly when tailored interventions are applied. These results seem to be maintained at the follow-up examinations (effect size = -0.52 [-0.78, -0.26]; P = 0.001). Promising findings on the potential benefits of physiotherapy in improving freezing of gait were found, although further randomized control trial studies are still needed. Questions remain on the type and duration of intervention that best fits for treating freezing of gait symptom in PD.

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“…Six of the studies compared the effects between real and sham rTMS, while one study performed dual stimulation comparing the effects of rTMS + tDCS and rTMS + sham tDCS. In a meta‐analysis of these six studies (91 PD patients), rTMS showed a beneficial effect on FoG questionnaire scores and Unified Parkinson's Disease Rating Scale (UPDRS)–III in PD patients (104). However, there were no significant differences in turning steps, turning time, or Timed Up and Go.…”

Section: Targets Of Neuromodulationmentioning

confidence: 99%

Freezing of Gait in Parkinson’s Disease: Invasive and Noninvasive Neuromodulation

Rahimpour

Gaztanaga

Yadav

et al. 2021

Neuromodulation: Technology at the Neural Interface

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Introduction: 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.Materials and Methods: 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. Conclusion: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.

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Effects of non-invasive brain stimulation on freezing of gait in parkinsonism: A systematic review with meta-analysis

Cited by 35 publications

References 28 publications

Freezing of gait in Parkinson’s disease: pathophysiology, risk factors and treatments

Freezing of gait in Parkinson’s disease: pathophysiology, risk factors and treatments

Effectiveness of Physiotherapy on Freezing of Gait in Parkinson's Disease: A Systematic Review and Meta‐Analyses

Freezing of Gait in Parkinson’s Disease: Invasive and Noninvasive Neuromodulation

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