A block to pre-prepared movement in gait freezing, relieved by pedunculopontine nucleus stimulation

Wesley Thevathasan; Alek Pogosyan; Jonathan A Hyam; Ned Jenkinson; Marko Bogdanovic; Terry J Coyne; Peter A Silburn; Tipu Z Aziz; Peter Brown

doi:10.1093/brain/awr131

A block to pre-prepared movement in gait freezing, relieved by pedunculopontine nucleus stimulation

Wesley Thevathasan, Alek Pogosyan, Jonathan A Hyam, Ned Jenkinson, Marko Bogdanovic, Terry J Coyne, Peter A Silburn, Tipu Z Aziz, Peter Brown

Sport, Exercise and Rehabilitation Sciences

Research output: Contribution to journal › Article › peer-review

55 Citations (Scopus)

Abstract

Gait freezing and postural instability are disabling features of Parkinsonian disorders, treatable with pedunculopontine nucleus stimulation. Both features are considered deficits of proximal and axial musculature, innervated predominantly by reticulospinal pathways and tend to manifest when gait and posture require adjustment. Adjustments to gait and posture are amenable to pre-preparation and rapid triggered release. Experimentally, such accelerated release can be elicited by loud auditory stimuli--a phenomenon known as 'StartReact'. We observed StartReact in healthy and Parkinsonian controls. However, StartReact was absent in Parkinsonian patients with severe gait freezing and postural instability. Pedunculopontine nucleus stimulation restored StartReact proximally and proximal reaction times to loud stimuli correlated with gait and postural disturbance. These findings suggest a relative block to triggered, pre-prepared movement in gait freezing and postural instability, relieved by pedunculopontine nucleus stimulation.

Original language	English
Pages (from-to)	2085-95
Number of pages	11
Journal	Brain
Volume	134
Issue number	Pt 7
DOIs	https://doi.org/10.1093/brain/awr131
Publication status	Published - Jul 2011

Keywords

Acoustic Stimulation
Aged
Analysis of Variance
Blinking
Deep Brain Stimulation
Electromyography
Female
Freezing Reaction, Cataleptic
Gait Disorders, Neurologic
Humans
Male
Middle Aged
Neurologic Examination
Neuropsychological Tests
Parkinson Disease
Pedunculopontine Tegmental Nucleus
Postural Balance
Reaction Time
Reflex, Startle
Sensation Disorders
Statistics as Topic
Statistics, Nonparametric
Clinical Trial
Journal Article
Research Support, Non-U.S. Gov't

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10.1093/brain/awr131

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title = "A block to pre-prepared movement in gait freezing, relieved by pedunculopontine nucleus stimulation",

abstract = "Gait freezing and postural instability are disabling features of Parkinsonian disorders, treatable with pedunculopontine nucleus stimulation. Both features are considered deficits of proximal and axial musculature, innervated predominantly by reticulospinal pathways and tend to manifest when gait and posture require adjustment. Adjustments to gait and posture are amenable to pre-preparation and rapid triggered release. Experimentally, such accelerated release can be elicited by loud auditory stimuli--a phenomenon known as 'StartReact'. We observed StartReact in healthy and Parkinsonian controls. However, StartReact was absent in Parkinsonian patients with severe gait freezing and postural instability. Pedunculopontine nucleus stimulation restored StartReact proximally and proximal reaction times to loud stimuli correlated with gait and postural disturbance. These findings suggest a relative block to triggered, pre-prepared movement in gait freezing and postural instability, relieved by pedunculopontine nucleus stimulation.",

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author = "Wesley Thevathasan and Alek Pogosyan and Hyam, {Jonathan A} and Ned Jenkinson and Marko Bogdanovic and Coyne, {Terry J} and Silburn, {Peter A} and Aziz, {Tipu Z} and Peter Brown",

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doi = "10.1093/brain/awr131",

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AU - Thevathasan, Wesley

AU - Pogosyan, Alek

AU - Hyam, Jonathan A

AU - Jenkinson, Ned

AU - Bogdanovic, Marko

AU - Coyne, Terry J

AU - Silburn, Peter A

AU - Aziz, Tipu Z

AU - Brown, Peter

PY - 2011/7

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N2 - Gait freezing and postural instability are disabling features of Parkinsonian disorders, treatable with pedunculopontine nucleus stimulation. Both features are considered deficits of proximal and axial musculature, innervated predominantly by reticulospinal pathways and tend to manifest when gait and posture require adjustment. Adjustments to gait and posture are amenable to pre-preparation and rapid triggered release. Experimentally, such accelerated release can be elicited by loud auditory stimuli--a phenomenon known as 'StartReact'. We observed StartReact in healthy and Parkinsonian controls. However, StartReact was absent in Parkinsonian patients with severe gait freezing and postural instability. Pedunculopontine nucleus stimulation restored StartReact proximally and proximal reaction times to loud stimuli correlated with gait and postural disturbance. These findings suggest a relative block to triggered, pre-prepared movement in gait freezing and postural instability, relieved by pedunculopontine nucleus stimulation.

AB - Gait freezing and postural instability are disabling features of Parkinsonian disorders, treatable with pedunculopontine nucleus stimulation. Both features are considered deficits of proximal and axial musculature, innervated predominantly by reticulospinal pathways and tend to manifest when gait and posture require adjustment. Adjustments to gait and posture are amenable to pre-preparation and rapid triggered release. Experimentally, such accelerated release can be elicited by loud auditory stimuli--a phenomenon known as 'StartReact'. We observed StartReact in healthy and Parkinsonian controls. However, StartReact was absent in Parkinsonian patients with severe gait freezing and postural instability. Pedunculopontine nucleus stimulation restored StartReact proximally and proximal reaction times to loud stimuli correlated with gait and postural disturbance. These findings suggest a relative block to triggered, pre-prepared movement in gait freezing and postural instability, relieved by pedunculopontine nucleus stimulation.

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KW - Analysis of Variance

KW - Blinking

KW - Deep Brain Stimulation

KW - Electromyography

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KW - Freezing Reaction, Cataleptic

KW - Gait Disorders, Neurologic

KW - Humans

KW - Male

KW - Middle Aged

KW - Neurologic Examination

KW - Neuropsychological Tests

KW - Parkinson Disease

KW - Pedunculopontine Tegmental Nucleus

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KW - Reaction Time

KW - Reflex, Startle

KW - Sensation Disorders

KW - Statistics as Topic

KW - Statistics, Nonparametric

KW - Clinical Trial

KW - Journal Article

KW - Research Support, Non-U.S. Gov't

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SP - 2085

EP - 2095

JO - Brain

JF - Brain

IS - Pt 7

ER -

A block to pre-prepared movement in gait freezing, relieved by pedunculopontine nucleus stimulation

Abstract

Keywords

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