Imaging gait disorders in parkinsonism: a review
- 1Université Joseph Fourier, Grenoble I, Grenoble, France
- 2INSERM, Grenoble Institut des Neurosciences, INSERM-UJF-CEA-CHU U836, Grenoble, France
- 3Centre Hospitalier Universitaire (CHU), Service de Neurologie, Grenoble, France
- 4Hôpitaux Universitaires de Genève, Genève, Switzerland
- Correspondence to A Maillet, Grenoble Institut des Neurosciences, U836 Inserm-UJF-CEA-CHU, Pavillon de Neurologie, Centre Hospitalier Universitaire de Grenoble, BP 217, 38043 Grenoble Cedex 9, France;
Contributors AM performed the systematic literature search, wrote the first draft of the paper as well as drafts of the revised papers. PP and BD supervised the writing of this review paper and critically reviewed the draft.
- Received 7 February 2012
- Revised 22 May 2012
- Accepted 23 May 2012
- Published Online First 8 July 2012
Gait difficulties—including freezing of gait—are frequent and disabling symptoms of advanced Parkinson's disease and other parkinsonian syndromes. They respond poorly to current medical and surgical treatments, making patient management very difficult. The underlying pathophysiology remains largely unknown. The late onset of levodopa resistance of Parkinson's disease gait abnormalities has been suggested to result from the progressive extension of the degenerative process to non-dopaminergic structures involved in locomotion, such as cortico-frontal and brainstem networks. Deficiencies in other neurotransmission systems, involving acetylcholine, serotonin or norepinephrine, have also been evoked. Neuroimaging tools appear well suited to decipher the cerebral substrates of parkinsonian gait disorders and their modulation by dopaminergic medication or deep brain stimulation. Here the main functional and metabolic neuroimaging studies aimed at identifying these cerebral networks are reviewed, in both healthy subjects and parkinsonian patients. After a brief overview of the physiology and pathophysiology of gait control, the methodology, main results and limits of the studies published to date are examined. The most promising methods to examine gait difficulties and their response to currently available treatments are then discussed.
Funding This work was supported by the Centre Hospitalier Universitaire de Grenoble, grant No PHRC 2009, and the University Joseph Fourier. AM also thanks the France Parkinson Association for her financial support.
Competing interests None.
Provenance and peer review Not commissioned; externally peer reviewed.