Transcranial Direct Current Stimulation
In general, anodal tDCS facilitates cortical excitability. In a crossover, double-blind, randomized, sham-controlled study including 10 PD patients with levodopa-resistant FOG, five sessions of 2mA anodal tDCS on primary motor cortex showed benefits on FOG and motor performance after tDCS . However, another crossover double-blind, randomized, sham-controlled study applied one session multibipolar tDCS electrodes stimulating only primary motor cortex in PD patients with FOG didnt improve FOG. But after stimulating both primary motor cortex and left dorsolateral prefrontal cortex, the performance in gait-provoking test, stroop, and time up and go tests were improved . Besides, another double-blinded crossover randomized, sham-controlled study including 10 PD with FOG showed a single dose of anodal tDCS over the SMAs did not improve self-initiated gait in PD and FOG .
Predictors Of Freezing: When Are People Living With Parkinsons Most Likely To Freeze
Freezing is common among Parkinsons patients, and is most often seen in those with long-standing symptoms.
A survey of 6,620 people living with Parkinsons disease found that 47% reported experiencing freezing regularly. Further analysis of people who reported freezing showed
- It was significantly associated with a longer disease duration and a more advanced stage of the disease.
- Episodes were more likely in men than in women and
- Finally, people who reported tremor as their main symptom were likely to also report freezing less frequently.
The results underline the necessity to develop appropriate countermeasures against this phenomenon, which is widely known to cause significant impairment of patients quality of life and as our data also showed may cause traffic accidents in licensed patients.
A previous study in 2001 has also established
- Risk factors associated with freezing where found to be at the early stages of the disease 1. the absence of tremor and 2. PD symptoms being mostly as a gait disorder early in the disease experience.
- The development of freezing over the course of the illness was also strongly associated with the development of balance and speech problems and less so with the worsening of bradykinesia , and was not associated with the progression of rigidity .
A current study rigorously compared studies and found that strong evidence supports the following risk factors for freezing
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New Drug To Treat Parkinsons Disease To Be Introduced In India
Apomorphine, which is derived from the water lily plant, has been found to control several neurodegenerative symptoms of Parkinsons and aid in improvement of the condition in many cases.
The blue water lily was used by ancient Egyptians as a sedative and intoxicant. Centuries later, scientists have now discovered that a derivative of the plant has a significant role to play in the treatment of Parkinsons disease. Apomorphine, which comes from the plant, has been found to control several neurodegenerative symptoms of Parkinsons and aids in improvement of the condition in many cases. This drug is now set to be available for the first time in India to treat those suffering from Parkinsons disease.
Around 300 to 400 people for every 100,000 population are diagnosed with Parkinsons in India, states Dr Shivam Om Mittal, Parkinsons Specialist from Bengaluru. It is expected to more than double by the year 2030 and will be a major non-communicable degenerative disorder among the people in the country. Speaking to the media on Thursday at an event held at Vikram Hospital in the city, introducing the drug to the Indian market, he along with several other experts talked about the impact of introducing the drug in India.
What is Parkinsons disease?
It is not as though the drug is not without its drawbacks.
Apomorphine pens
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Ways To Manage Freezing
From treatments such as physiotherapy, to cueing techniques you can do yourself, there are different things that can help you manage freezing.
Speak to your GP, specialist or Parkinsons nurse about the best treatment for your freezing. They can also refer you for therapy that may help. Treatments include:
Understanding Phenomenology And Pathophysiology
Despite an abundance of clinical experience from direct observations, there are still a significant number of fundamental gaps in our understanding of FOG despite the proposal of several pathophysiological models . These range from the very basic grasp we have on phenomenology through to the more nuanced appreciation of its underlying neurobiology that manifests clinically.
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So What Circuits Arent Working
- Out of Sync Limbic System and Cognition regulated by the basal ganglia as well as the supplementary motor area, cerebral cortex and more recently supraspinal locomotor network and being referred to a circuitopathy
- Support to this circuitopathy is getting greater recognition by studies showing that FOG is correlated with limited dual-tasking ability and inability to set-shift attention among motor, limbic, and cognitive networks.
- In addition, freezing can occur during speech, handwriting, and other actions aside from gait, suggesting that the dysfunction occurs in generalized neural networks not solely related to ambulation.
- The limbic system is the part of the brain involved in our behavioural and emotional responses, especially when it comes to behaviours we need for survival: feeding, reproduction and caring for our young, and fight or flight responses
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Electrophysiological Signal Recording And Analysis
The subthalamic LFP recordings were combined with measures of the cortical electrophysiological activity using a 64-channel portable EEG . EEG signals were acquired with the sampling frequency at 1000 Hz and resampled at 400 Hz to match the STN LFP sampling frequency and optimize signals alignment for connectivity analyses. Low frequency and high frequency were eliminated using a bandpass Kaiser windowed FIR filter . Power line noise was eliminated using a bandstop fourth order Butterworth filter. EEG channels affected by bad scalp-electrode were visually identified and replaced with spherical spline interpolation. Stereotypical artefacts were removed by independent component analysis . Laplacian montage was applied to reduce muscular artefacts . We ruled out the effect of movement artefacts by comparing the wavelet transformation of epochs of walking with epochs of gait freezing, focusing on the 13 Hz band. In this frequency band, the epochs of walking and gait freezing showed similar spectral profiles, thus further excluding a confounding effect due to movement artefacts.
We first computed the power in the specific – and -frequency bands of the two STN and compared it between walking and the abovementioned time frames of gait freezing.
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Strategies For Improving Adherence To Interventions
We will adopt a variety of strategies to improve adherence to interventions. For example, we hope to establish a good relationship with the participants and fully simplify the intervention program to win their trust and cooperation. In addition, we will strengthen guidance to the participants and strive to understand and solve their problems in time to eliminate any concerns.
Database Management And Quality Control
Our research team will take effective measures to ensure the quality of research. Particularly, we will adopt the double entry method in order to ensure quality of data. The statistician will compare the two databases through the program, and in case of inconsistencies in the input results, he/she will check to identify the error. After final confirmation, the database will be saved and kept by a special person. Any future changes to the database shall be agreed upon, in writing, by the clinical study director, statistician, and data manager.
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Tips To Get Moving Again
When you get stuck, these tricks from the National Parkinson Foundation can help:
- Be aware of freezing triggers and prepare strategies in advance.
- Shift the weight of your body from one leg to another.
- Listen to music and step with the rhythm.
- Hum, sing, or count.
- Imagine a line to step over or focus on a target on the floor to step on.
- Use a mobile laser device to create a line in front of you to step over.
- Turn by walking half a circle instead of by a pivot turn.
Definition Of Parkinsons Disease:
Parkinsons is a chronic progressive degenerative disorder affecting mainly people above the age of 60. Males are more prone than females. Worldwide prevalence is 0.3 1 %. If we talk about India alone, Parkinsons disease is the second leading chronic degenerative disorder after Alzheimers, with a prevalence that is directly proportional to age. Between the age of 70-79 years, it could be as high as 280 for a Hundred thousand people.
Parkinsons disease is a disorder that impacts the brain and leads to difficulty with balancing, coordination and walking. Along with this, the patient also experiences shaking and stiffness.
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What Freezing Is Like For My Dad
Like many Parkinsons patients, my dad notices that he usually only freezes when hes not on his medication. It usually happens while hes moving through doors: When you pivot youre worried about losing your balance. Thats why we shuffle our feet and take baby steps initially. Once Im moving Im fine, he says.
Since hes worried about maintaining balance while navigating, its possible that theres a connection between fear and freezing. Continuous motion seems to bypass the risk of freezing, while shifting motion types can present challenges.
Shake Off Your Stress
Freezing episodes are more frequent and intense when youre anxious. Anxiety leads you to tense up your hands, arms, shoulders and jaw which raises stress in your body and feeds your freezing, making you even more anxious!
To combat this vicious cycle, deliberately give your body a good shake before you start walking. Start with loosening and shaking your hands, arms, shoulders, neck and tongue. Take a deep breath, stay as relaxed as possible and set out towards your destination!
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Subthalamic Oscillatory Activity And Connectivity During Gait Freezing
To investigate the role of the STN neural activity in gait freezing we compared the STN oscillations between walking and ongoing freezing episodes. We first studied power changes in low frequency and in the -frequency band of the two STN and did not find any differences during gait freezing in comparison to walking . We also assessed the duration of -burst and did not find a difference between walking and gait freezing . We finally investigated the subthalamic interhemispheric coupling in the -band and showed an increase of -coupling followed by a reduction in the synchronization between the two STN during gait freezing. However, this change did not reach statistical significance .
Freezing Of Gait In Parkinsons Disease
This short webpage explains what freezing of gait is, why it occurs, and treatment. It also offers 10 tips to prevent freezing or get unstuck. Finally, there is a discussion of walkers that can prevent injury due to falls when freezing episodes are severe and the future of treatments for freezing of gait.
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Why Does Freezing Of Gait Occur
It is not completely clear why some people with PD experience freezing of gait and others do not. Research suggests that there is a relationship between freezing of gait and cognitive difficulties. The brain circuitry that controls gait is extremely complex and involves multiple connections between various parts of the brain, including:
- areas in the front of the brain that plan and initiate movement
- areas of the basal ganglia where the dopaminergic neurons that refine and control movement are found
- areas in the brainstem which modulate movement and wakefulness
Freezing of gait seems to be caused by short-lasting episodes of inhibition of these brain circuits that coordinate gait. The specific abnormalities that cause the problem may differ from person to person.
Parkinson’s & Freezing Of Gait
During his time at the Stanford Movement Disorders Center Brent Bluett, DO, researched indicators for who is most likely to develop freezing of gait in PD. In this 45-minute Lunch with Docs episode Dr. Bluett provides an overview of FOG, shares tips for breaking a freeze, treatment options , summarizes the results of his research and other research into FOG. He spends about half the webinar answering questions.
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Why Its A Problem:
Freezing is a very frustrating symptom of PD and can cause people to feel self-conscious and anxious about movement. This results in avoiding activity and movement, which unfortunately perpetuates the freezing tendencies even further.
Freezing also contributes to a person having a higher risk of falling and can significantly limit them from participating in meaningful activities due to a fear of getting stuck. And while some people with Parkinsons never experience Freezing, it is estimated that approximately 80% of people with PD will develop challenges associated with Freezing.
Techniques To Overcome Freezing
Physical therapy and occupational therapy can be helpful to reduce or overcome freezing episodes. Physical therapy focuses on the physical rehabilitation of people recovering from injuries or disease with the goal of restoring mobility, as well as educating patients on managing their condition to maintain long-term benefits. Occupational therapy also deals with rehabilitation and motion but is focused more on enabling the person to engage in daily activities as seamlessly as possible. Occupational therapists also suggest adaptations and modifications to the persons environment.3
There are several techniques that can help people with PD overcome freezing, including:
As with any symptom, patients who experience freezing episodes should mention this to their neurologist who is managing their care. The neurologist may make changes to medication or provide a referral to a physical or occupational therapist.
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Ten Tips To Put The Freeze On Freezing
While these methods can be helpful to get out of a freeze that is already underway, physical therapy techniques that incorporate these types of cueing strategies are utilized to reduce freezing of gait overall. Rhythmic auditory cueing is one such technique which utilizes rhythm and music to improve gait in PD and other neurologic diseases.
Balance And The Brain
Difficulties with balance and walking are linked to the brain changes that take place with PD. For people who dont have PD, balance is automatic, a reflex. But Parkinsons affects the basal ganglia . To compensate, the brain assigns another brain area an area used for thinking to take over. The thinking part of the brain, mainly the frontal cortex, cant control balance automatically. The result: for many people with PD, balance becomes less automatic.
This means that when people experience freezing and fall, they cant adjust their balance automatically. Taking small steps to try and regain balance can make things worse, because it involves shifting weight with each step. The brain changes from PD inhibit their ability to take a big step to catch their balance and avoid a fall. For some, the drug levodopa can help prevent freezing, but does not improve balance.
A person whose balance is less automatic must pay more attention while walking. For everyone, walking slows down when were talking and thinking slows down when were walking. This is called the dual-task cost and its higher in people with PD. That tells us that people with PD are using more attention and more cognitive control for balance and gait.
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Parkinsons Disease Stem Cell Treatment
Parkinsons disease happens when there is a problem with certain nerve cells in the brain. This disease affects the way you move because of the inadequate production of dopamine, which is an important chemical that sends signals to the part of the brain that controls movement. Parkinsons is a progressive disease whose symptoms take a few years to surface.
Parkinsons is an illness that affects the central nervous system with a direct blow on the brain and spinal cord and usually only affects adults. More specifically, this disease damages a group of nerve cells in the deepest part of the brain called the Basal Ganglia. There are quite a few reasons leading to Parkinsons disease, including aging and poisons in the environment. To cure Parkinsons disease, stem cell treatment is highly popular.
These nerve cells make and use a brain chemical called dopamine to send messages to other parts of the brain to coordinate body movements. When someone suffers from Parkinsons disease, the dopamine levels are low. So, the body doesnt get the right messages required to move normally.
About 1 million people in the United States alone have Parkinsons, and both men and women can be affected by it. It usually affects the elderly population, someone older than 50, and it becomes common as people get older.
- Problems with balance or walking
Tremor, which essentially means shaking or trembling. Tremors may affect your hands, arms, or legs.