Brain metabolic abnormalities during gait with freezing in Parkinson's disease.
BACKGROUND
Freezing of gait (FoG) is a debilitating gait disorder in Parkinson's disease (PD). In advanced PD patients with FoG, the supraspinal locomotor network may be dysregulated (relative to similar patients without FoG) during gait. Here, we sought to characterize the metabolism of locomotor networks involved in FoG.


METHODS
Twenty-two PD patients (11 with off-drug FoG and 11 without) each underwent two [(18)F]-fluorodeoxyglucose PET brain scans in the off-drug state: one at rest and another during radiotracer uptake while performing a standardized gait trajectory that incorporated the usual triggers for FoG.


RESULTS
For the 11 freezers, FoG was present for 39% (± 23%) of the time during the gait trajectory. The FoG-associated abnormalities were characterized by (i) hypometabolism in frontal regions (the associative premotor, temporopolar and orbitofrontal areas, i.e. Brodmann areas 6 and 8), (ii) hypermetabolism in the paracentral lobule (Brodmann area 5), and (iii) deregulation of the basal ganglia output (the globus pallidus and the mesencephalic locomotor region).


CONCLUSIONS
FoG during a real gait task was associated with impaired frontoparietal cortical activation, as characterized by abnormally low metabolic activity of the premotor area (involved in the indirect locomotor pathway) and abnormally high metabolic activity of the parietal area (reflecting the harmful effect of external cueing).
Service de Neurologie et Pathologie du mouvement, Hôpital Roger Salengro, CHRU de Lille, Lille, France; U1171, Université Lille, Lille, France. Electronic address: celinetard@gmail.com.
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Tard
Service de Neurologie et Pathologie du mouvement, Hôpital Roger Salengro, CHRU de Lille, Lille, France; U1171, Université Lille, Lille, France.
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Delval
Service de Neurologie et Pathologie du mouvement, Hôpital Roger Salengro, CHRU de Lille, Lille, France; U1171, Université Lille, Lille, France; Service de Pharmacologie médicale, Faculté de Médecine Lille, CHRU de Lille, Lille, France.
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Devos
U1171, Université Lille, Lille, France; Service de Neuroradiologie clinique, Hôpital Roger Salengro, CHRU de Lille, Lille, France.
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Lopes
Service de Médecine Nucléaire, Hôpital Roger Salengro, CHRU de Lille, Lille, France.
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Lenfant
Service de Neurologie et Pathologie du mouvement, Hôpital Roger Salengro, CHRU de Lille, Lille, France; U1171, Université Lille, Lille, France.
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Dujardin
U1171, Université Lille, Lille, France; Service de Médecine Nucléaire, Hôpital Roger Salengro, CHRU de Lille, Lille, France.
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Hossein-Foucher
U1171, Université Lille, Lille, France; Service de Médecine Nucléaire, Hôpital Roger Salengro, CHRU de Lille, Lille, France.
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Semah
Service de Biostatistiques de santé publique, CHRU de Lille, Lille, France.
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Duhamel
Service de Neurologie et Pathologie du mouvement, Hôpital Roger Salengro, CHRU de Lille, Lille, France; U1171, Université Lille, Lille, France.
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Defebvre
Service de Médecine Nucléaire, Centre Eugène Marquis, Rennes, France.
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Le Jeune
Service de Neurologie et Pathologie du mouvement, Hôpital Roger Salengro, CHRU de Lille, Lille, France; U1171, Université Lille, Lille, France.
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Moreau
D000368:Aged; D001921:Brain / Q000000981:diagnostic imaging / Q000378:metabolism*; D016000:Cluster Analysis; D005260:Female; D019788:Fluorodeoxyglucose F18; D020233:Gait Disorders, Neurologic / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010300:Parkinson Disease / Q000000981:diagnostic imaging / Q000473:pathology*; D049268:Positron-Emission Tomography; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric
D019788:Fluorodeoxyglucose F18
PET; associative somatosensory cortex; executive-attention network; premotor cortex; temporopolar area