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首页> 外文期刊>Experimental Brain Research >The role of the prefrontal cortex in freezing of gait in Parkinson's disease: insights from a deep repetitive transcranial magnetic stimulation exploratory study
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The role of the prefrontal cortex in freezing of gait in Parkinson's disease: insights from a deep repetitive transcranial magnetic stimulation exploratory study

机译：前额叶皮质在帕金森病的冻结中的作用：深度重复经颅磁刺激探究性研究的见解

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Freezing of Gait (FOG) is one of the most debilitating gait impairments in Parkinson's disease (PD), leading to increased fall risk and reduced health-related quality of life. The utility of parkinsonian medications is often limited in the case of FOG and it frequently becomes dopamine resistant. Recent studies have suggested that pre-frontal cortex (PFC) dysfunction contributes to FOG; however, most previous findings provide only indirect evidence. To better understand the role of the PFC, we aimed to investigate the impact of high frequency, deep, repetitive transcranial magnetic stimulation (drTMS) of the medial PFC on FOG and its mediators. Nine patients with advanced PD participated in a randomized, cross-over exploratory study. We applied drTMS over the medial PFC for 16 weeks, with real and sham conditions; each condition included an intensive (i.e., 3 times a week) phase and a maintenance (once a week) phase. Scores on a FOG-provoking test, the motor part of the Unified Parkinson's Disease Rating Scale, and gait variability significantly improved after real drTMS, but not after the sham condition. Self-report of FOG severity and cognitive scores did not improve. Due to discomfort and pain during treatment, two patients dropped out and the study was halted. These initial findings support the cause-and-effect role of the pre-frontal cortex in FOG among patients with PD. Due to the small sample size, findings should be interpreted cautiously. Further studies are needed to more fully assess the role of the medial PFC in the underlying mechanism of FOG and the possibility of using non-invasive brain stimulation to modify FOG.
机译：步态（雾）冷冻是帕金森病（PD）中最令人衰弱的步态障碍之一，导致跌倒风险和减少与健康有关的生活质量。 Parkinsonian药物的效用通常在雾的情况下限制，并且经常成为多巴胺的抗性。最近的研究表明，前额前皮质（PFC）功能障碍有助于雾;然而，最先前的发现只提供间接证据。为了更好地了解PFC的作用，我们旨在调查中间PFC对雾及其介质的高频，深，复合经颅磁刺激（DRTM）的影响。九名高级PD患者参加了随机交叉探索性研究。我们在内侧PFC上施加了DRTM 16周，具有实际和虚无条件;每个条件包括一个密集的（即，每周3次）阶段和维护（每周一次）阶段。分数对迷人挑衅的试验，统一帕金森病评级规模的电机部分，并且在真正的DRTM后的步态变异显着改善，但不在虚假条件后。雾严重程度和认知分数的自我报告并没有改善。由于治疗过程中的不适和疼痛，两名患者退出并停止了这项研究。这些初步调查结果支持PD患者中逆前皮层的原因和效应作用。由于样品大小小，调查结果应谨慎地解释。需要进一步的研究，以更充分地评估内侧PFC在雾的潜在机制中的作用以及使用非侵入性脑刺激来修饰雾的可能性。

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