title: Freezing of gait and white matter changes: a tract-based spatial statistics study.
abstract: BACKGROUND
  We hypothesized that the integrity of white matter might be related to the severity of freezing of gait in age-related white matter changes.
  
  
  METHODS
  Twenty subjects exhibiting excessive hyperintensities in the periventricular and deep white matter were recruited. The subjects underwent the Freezing of Gait Questionnaire, computerized gait analyses, and diffusion tensor magnetic resonance imaging. Images of axial, radial and mean diffusivity, and fractional anisotropy were calculated as indices of white matter integrity and analyzed with tract-based spatial statistics.
  
  
  RESULTS
  The fractional anisotropy, mean, axial and radial diffusivity averaged across the whole white matter structure were all significantly correlated with Freezing of Gait Questionnaire scores. Regionally, a negative correlation between Freezing of Gait Questionnaire scores and fractional anisotropy was found in the left superior longitudinal fasciculus beneath the left premotor cortex, right corpus callosum, and left cerebral peduncle. The scores of the Freezing of Gait Questionnaire were positively correlated with mean diffusivity in the left corona radiata and right corpus callosum, and with both axial and radial diffusivity in the left corona radiata. The white matter integrity in these tracts (except the corpus callosum) showed no correlation with cognitive or other gait measures, supporting the specificity of those abnormalities to freezing of gait.
  
  
  CONCLUSIONS
  Divergent pathological lesions involved neural circuits composed of the cerebral cortex, basal ganglia and brainstem, suggesting that freezing of gait has a multifactorial nature.
authors.affiliation: Human Brain Research Center, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507 Japan ; Human Motor Control Section, Medical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD USA ; Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University, Graduate School of Medicine, Sendai, Miyagi Japan ; Department of Neurology, Sakakibara-Hakuho Hospital, Tsu, Mie Japan.
authors.forename: Kazumi
authors.initials: K
authors.lastname: Iseki
authors.affiliation: Human Brain Research Center, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507 Japan.
authors.forename: Hidenao
authors.initials: H
authors.lastname: Fukuyama
authors.affiliation: Human Brain Research Center, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507 Japan.
authors.forename: Naoya
authors.initials: N
authors.lastname: Oishi
authors.affiliation: Department of Neurology, Mie University, Graduate School of Medicine, Tsu, Mie Japan.
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Tomimoto
authors.affiliation: Human Brain Research Center, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507 Japan.
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Otsuka
authors.affiliation: Department of Physical Therapy, Kyoto University Hospital, Kyoto, Japan.
authors.forename: Manabu
authors.initials: M
authors.lastname: Nankaku
authors.affiliation: Human Motor Control Section, Medical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD USA.
authors.forename: David
authors.initials: D
authors.lastname: Benninger
authors.affiliation: Human Motor Control Section, Medical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Hallett
authors.affiliation: Human Brain Research Center, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507 Japan ; Department of Advanced Neuroimaging, Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, Kodaira, Japan ; PRESTO, JST, Kawaguchi, Saitama Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Hanakawa
keywords: Age-related white matter change (ARWMC); Diffusion tensor imaging (DTI); Disconnection; Freezing of gait (FOG); Tract-based spatial statistics (TBSS); Vascular Parkinsonism