Side of basal ganglia degeneration influences freezing of gait in Parkinson’s disease.

Abstract

Although the role of hemispheric laterality in freezing of gait (FOG) remains a topic of debate, important new evidence has suggested that individuals with Parkinson's disease (PD) who experience freezing of gait (PD-FOG) may have decreased activity in the circuitry of the right fronto-parietal cortices, irrespective of the side of basal ganglia (BG) degeneration. Because the right hemisphere plays an important role in monitoring sensorimotor information during movements, and cortical regions interact with BG loops, one could expect that right cortical dysfunction in PD-FOG might be exacerbated by right sided BG damage (compared to left). The current study aimed to evaluate the influence of asymmetrical BG degeneration on self-paced gait in PD-FOG and PD-nonFOG. This study compared gait performance in predominantly left- or right-side affected PD patients with or without freezing of gait (LFOG = 11, RFOG = 10, LPD = 15, RPD = 11). Participants were instructed to walk 10m on a GaitRite® carpet. As expected, gait parameters in PD-FOG were worse compared to PD-nonFOG. The spatiotemporal aspects of gait did not differ between LPD and RPD (nonFOG patients). Contrary to our hypothesis, RFOG (predominantly right side symptoms) had a shorter step length, increased step time variability and tended to walk slower compared with LFOG. Thus, rather than severely impaired right hemisphere circuitries exacerbating gait impairments, worse gait may be a consequence of both hemispheres being affected in PD-FOG.

Predicting the onset of freezing of gait in de novo Parkinson’s disease

“…Despite the heterogeneity of neuronal mechanisms in FoG development, anti-coupling between cognitive cortical regions and the caudate nucleus was an independent factor of symptom severity, representing common neural underpinnings of freezing 45 . While evidence suggested the role of hemispheric laterality played in the development of freezing, no difference in the side of striatum degeneration, indicated by the count density ratio in our analysis was observed in our study 46 .…”

Potential Non-invasive Brain Stimulation Targets to Alleviate Freezing of Gait in Parkinson’s Disease

“…Some consider FOG as a bilateral symptom usually appearing in later stages of PD, when other motor symptoms are already bilateral, and because it consists of a bilateral cessation of movement (Plotnik et al, 2005). Others have associated FOG to changes predominantly in the right (Bartels and Leenders, 2008) or in the left (Pieruccini-Faria et al, 2015) brain circuity. We thus suggest that the choice of the hemisphere to target should be based on the particularities of each cortical region.…”

Impaired structural and reserved functional topological organizations of brain networks in Parkinson’s disease with freezing of gait

“…Fourth, altered nodes between PD-FOG and PD-nFOG were detected solely in the left hemisphere, which was not due to lateral heterogeneity of dominant motor symptoms. Although previous studies have shown right cortical and subcortical abnormalities in PD-FOG (47), the role of hemispheric laterality in PD-FOG remains controversial (66). Thus, our findings provide evidence that the pathophysiological mechanisms of PD-FOG are also implicated in the left hemisphere.…”