Objective: The objective of this review is to summarize the results of brain imaging studies assessing freezing of gait (FOG) and to provide new ideas for the management of FOG.

Background: FOG is a common motor symptom in Parkinson’s disease (PD) affecting up to 80% of adults in advanced PD [1]. In the last decades, studies have used several different brain imaging techniques and paradigms to explore the pathophysiology of FOG. Although the literature generally agrees that FOG is related to decreased activity in brainstem structures that organize gait due to an increased inhibitory drive from the basal ganglia [2], possible mechanisms leading to FOG have not been confirmed. Because FOG remains a mysterious motor symptom, there are few pharmacological, surgical and behavioural treatments options. In terms of rehabilitative interventions, there are currently no standardized approach for FOG. Thus, there is a clear need to better understand FOG pathophysiology in order to develop therapies specifically targeting FOG.

Method: The review was performed using Pubmed. To review neuroimaging literature in FOG, search terms included, among others,‘‘brain imaging’’, ‘‘magnetic resonance imaging’’, ‘‘positron emission tomography’’ and ‘‘freezing of gait’’.

Results: FOG seems to be associated with atrophy and altered activity in specific cognitive, limbic and sensorimotor areas thought to be involved in the different loops of the cortico-basal ganglia circuity. Brain connectivity also seems to be altered in FOG, especially within the visual, the frontoparietal and the sensorimotor networks.

Conclusion: FOG seems to be related to dysfunctional processing in the cortico-basal ganglia circuity. By knowing the proper neural mechanisms of FOG, non-invasive brain stimulation interventions, such as rTMS, could modify cortical excitability of appropriate brain areas. Combined with a gait and stability training, such rTMS interventions may have the potential to improve FOG.

References: [1] Tan, D. M., McGinley, J. L., Danoudis, M. E., Iansek, R., & Morris, M. E. (2011). Freezing of gait and activity limitations in people with Parkinson’s disease. Arch Phys Med Rehabil, 92(7), 1159–1165. doi:10.1016/j.apmr.2011.02.003 [2] Lewis, S. J., & Shine, J. M. (2016). The Next Step: A Common Neural Mechanism for Freezing of Gait. The Neuroscientist, 22(1), 72–82.

« Back to 2019 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/freezing-of-gait-in-parkinsons-disease-a-review-of-current-neuroimaging-evidence-for-the-development-of-effective-therapies/