Regional cerebral blood flow patterns in patients with freezing of gait due to lacunar infarction: SPECT study using three-dimensional stereotactic surface projections.
ABSTRACT Although freezing of gait (FOG) is reportedly caused by cerebrovascular disease, few studies have examined its pathology. We examined regional cerebral blood flow (rCBF) patterns in patients with FOG resulting from chronic lacunar infarction using single-photon emission computed tomography (SPECT).
Among patients with chronic lacunar infarction treated at our outpatient unit, we performed N-isopropyl-p-[(123)I]-iodoamphetamine SPECT in seven patients with FOG (FOG group) and in 20 patients without FOG (non-FOG group). We analyzed and compared the SPECT data using three-dimensional stereotactic surface projections of the two groups.
On z-score maps, the FOG group showed a significant reduction in rCBF in the bilateral anterior cingulate cortices compared with the non-FOG group. The mean z-score for the bilateral cingulate gyri was significantly higher in the FOG group than in the non-FOG group (p < .01). When the cingulate gyrus data of the anterior and posterior subregions were analyzed on a region-by-region basis, the mean z-score for the left anterior cingulate gyrus was significantly higher than that for the right cingulate gyrus (p < .05).
These results suggest that anterior cingulate cortex dysfunction may be involved in the pathology of FOG in patients with chronic lacunar infarction.
Article: Freezing of gait. Clinical overview.Advances in neurology 02/2001; 87:191-7.
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ABSTRACT: The aim of this study was to define the symptoms and signs of suspected vascular parkinsonism (VP) which is still a debatable concept. Patients with parkinsonism were grouped into patients with suspected VP and Parkinson's disease (PD) after other causes for secondary parkinsonism, and parkinsonism-plus syndromes were excluded. The clinical features of 16 patients with suspected VP to those of 50 diagnosed with PD were compared. All patients were assessed using unified Parkinson's disease rating scale (UPDRS) and all had cerebral MRIs. Patients with VP had significantly older onset age and shorter duration of disease with gait disorder as the most frequent initial symptom. All PD patients had satisfactory response to levodopa treatment, whereas only 38% VP patients had satisfactory response to levodopa treatment. Vascular risk factors were more common in VP (81%) than PD (32%). Postural instability, freezing, gait disturbance, pyramidal signs, and postural tremor were significantly more prevalent in patients with VP than in PD. In VP patients these features were more prominent in the lower limbs. Twenty-five percent had acute onset VP. All patients with VP had ischemic lesions, mainly in subcortical white matter, to a lesser extent basal ganglia and brainstem, in their cerebral MRIs, while 70% of PD patients had normal MRIs. The differences in the clinical features support the concept that VP is a distinct clinical entity with heterogeneous clinical, MRI, and possibly pathophysiological features.Acta Neurologica Scandinavica 09/2001; 104(2):63-7. · 2.47 Impact Factor
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ABSTRACT: The human frontomesial cortex reportedly contains at least four cortical areas that are involved in motor control: the anterior supplementary motor area (pre-SMA), the posterior SMA (SMA proper, or SMA), and, in the anterior cingulate cortex, the rostral cingulate zone (RCZ) and the caudal cingulate zone (CCZ). We used functional magnetic resonance imaging (fMRI) to examine the role of each of these mesial motor areas in self-initiated and visually triggered movements. Healthy subjects performed self-initiated movements of the right fingers (self-initiated task, SI). Each movement elicited a visual signal that was recorded. The recorded sequence of visual signals was played back, and the subjects moved the right fingers in response to each signal (visually triggered task, VT). There were two types of movements: repetitive (FIXED) or sequential (SEQUENCE), performed at two different rates: SLOW or FAST. The four regions of interest (pre-SMA, SMA, RCZ, CCZ) were traced on a high-resolution MRI of each subject's brain. Descriptive analysis, consisting of individual assessment of significant activation, revealed a bilateral activation in the four mesial structures for all movement conditions, but SI movements were more efficient than VT movements. The more complex and more rapid the movements, the smaller the difference in activation efficiency between the SI and the VT tasks, which indicated an additional processing role of the mesial motor areas involving both the type and rate of movements. Quantitative analysis was performed on the spatial extent of the area activated and the percentage of change in signal amplitude. In the pre-SMA, activation was more extensive for SI than for VT movements, and for fast than for slow movements; the extent of activation was larger in the ipsilateral pre-SMA. In the SMA, the difference was not significant in the extent and magnitude of activation between SI and VT movements, but activation was more extensive for sequential than for fixed movements. In the RCZ and CCZ, both the extent and magnitude of activation were larger for SI than for VT movements. In the CCZ, both indices of activation were also larger for sequential than for fixed movements, and for fast than for slow movements. These data suggest functional specificities of the frontomesial motor areas with respect not only to the mode of movement initiation (self-initiated or externally triggered) but also to the movement type and rate.Journal of Neurophysiology 07/1999; 81(6):3065-77. · 3.30 Impact Factor