Physiology of freezing of gait

• Published in: Annals of neurology Vol. 80; no. 5; pp. 644 - 659
• Main Authors: Snijders, Anke H., Takakusaki, Kaoru, Debu, Bettina, Lozano, Andres M., Krishna, Vibhor, Fasano, Alfonso, Aziz, Tipu Z., Papa, Stella M., Factor, Stewart A., Hallett, Mark
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01-11-2016; Wiley Subscription Services, Inc
• Subjects: Animal models; Animals; Balance; Data processing; Deep Brain Stimulation; Etiology; Functional Neuroimaging; Gait; Gait Disorders, Neurologic - etiology; Gait Disorders, Neurologic - physiopathology; Gait Disorders, Neurologic - therapy; Humans; Information processing; Magnetic resonance; Movement disorders; Neostriatum; Neurodegenerative diseases; Parkinson's disease; Pedunculopontine Tegmental Nucleus; Physiology; Sensory neurons; Stimulation; Substrates; Supplementary motor area
• ISSN: 0364-5134; 1531-8249
• DOI: 10.1002/ana.24778

Freezing of gait (FOG) is a common and debilitating, but largely mysterious, symptom of Parkinson disease. In this review, we will discuss the cerebral substrate of FOG focusing on brain physiology and animal models. Walking is a combination of automatic movement processes, afferent information processing, and intentional adjustments. Thus, normal gait requires a delicate balance between various interacting neuronal systems. To further understand gait control and specifically FOG, we will discuss the basic physiology of gait, animal models of gait disturbance including FOG, alternative etiologies of FOG, and functional magnetic resonance studies investigating FOG. The outcomes of these studies point to a dynamic network of cortical areas such as the supplementary motor area, as well as subcortical areas such as the striatum and the mesencephalic locomotor region including the pedunculopontine nucleus (PPN). Additionally, we will review PPN (area) stimulation as a possible treatment for FOG, and ponder whether PPN stimulation truly is the right step forward. Ann Neurol 2016;80:644–659