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Towards a Better Understanding of Treatment-refractory Gait Issues in Parkinson’s Disease

Study Rationale: Freezing of gait (FOG) is a sudden arrest of gait despite the intention to continue walking, often while a person is turning, walking in a confined space or is in a situation that seems to require increased cognitive valence. FOG is most commonly encountered in advanced stages of Parkinson’s disease (PD), but it is also seen in many atypical parkinsonisms, for instance early on in progressive supranuclear palsy (PSP), vascular parkinsonism and normal pressure hydrocephalus (NPH). Unlike other motor symptoms of PD, FOG is very refractory to treatment, and leads to frequent falling. Thus, the development of FOG is often the main driver in significant declines in quality of life for PD and atypical parkinsonism patients.

Hypothesis: We will study gait and movement in a quantitative manner while concurrently monitor changes in brain networks in these different disorders. By identifying the pathways involved in gait, we will be able to find novel ways to diagnose and treat gait dysfunction in PD and atypical parkinsonisms.

Study Design: We plan to use novel video capture algorithms in conjunction with traditional measures of gait and movement to come up with a more refined and quantitative gait signature in patients with idiopathic PD and atypical parkinsonisms. We plan to further understand FOG by correlating this physical gait signature with measures of brain function via DBS sensing electrodes in a subgroup of PD patients. In a subgroup of the patients with PD and FOG we are studying, we plan to also implant spinal cord stimulators, to examine the effects of spinal cord input in ameliorating FOG. We will be examining brain networks involved by imaging patients via FDG-PET.

Impact on Diagnosis/Treatment of Parkinson’s disease: We hope to improve how we are able to diagnose PD and atypical parkinsonisms earlier on, and by better understanding the pathophysiology of these disparate illnesses, hope to find treatments that will be disease modifying and even preventative.

Next Steps for Development: If the study results are positive, we hope to apply the gait assessments more broadly in the clinic, and then transitioning these methods to videorecordings done through telemedicine, and thus improve the diagnostic abilities of movement disorder clinicians. We will apply the use of spinal cord stimulators more broadly in treating gait dysfunction in PD and atypical parkinsonisms.


  • Kimberly Tsu Kwei, MD, PhD

    New York, NY United States

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