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Freezing of Gait (FOG) is a disabling symptom of Parkinson's disease (PD) and a leading cause for falls. Current medical management is inadequate to alleviate FOG so there is need for improved treatments. A major draw-back in the development of better treatments for FOG is the difficulty in detecting episodes and our poor understanding of its underlying pathophysiology.
This study will investigate the cortical signature of FOG using ambulatory electroencephalography (EEG) to help improve FOG detection algorithms and provide novel insights into the underlying pathophysiology, which together will guide therapy development.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Home assessment | All 28 participants will undergo a single home based assessment including a gait protocol as well as administering clinimetrics and questionnaires. Patients will be tested early in the morning after at least 12 hours without the anti-parkinsonian medication (= 'partial' OFF medication) and then about 1 hour after the intake of the first morning medication dose, when the subject reports reaching self-reported ON state (= ON medication). The gait protocol consist out of A) a trajectory in the participants home from the living room towards the bathroom and back, including a 360° turn as well as a figure-8 turn and going through a doorway and B) a daily living task. All tests will be conducted in a fixed order. The protocol will be conducted as a single task, with a dual task (serial subtraction task), with voluntary stops during different parts of the trajectory, and with an auditory cue (rhythm set 10% slower then typical cadence). |
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| Measure | Description | Time Frame |
|---|---|---|
| Power spectral density (Watts/hertz) of beta frequencies | The averaged power spectral density (PSD) of the beta (12-25 Hz) frequency band measured over the motor cortices during freezing of gait (FOG) episodes compared to typical gait performance in the same individual with Parkinson's disease as measured during different walking trajectories in the home setting. | During walking protocol (duration 15-20 minutes) |
| Measure | Description | Time Frame |
|---|---|---|
| Power spectral density (Watts/hertz) of theta frequencies bands | The averaged power spectral density (PSD) of the theta (4-7 Hz) frequency band measured over the prefrontal cortices during freezing of gait (FOG) episodes compared to typical gait performance in the same individual with Parkinson's disease as measured during different walking trajectories in the home setting. | During walking protocol (duration 15-20 minutes) |
| Measure | Description | Time Frame |
|---|---|---|
| Power spectrum density and cross-frequency coupling in ON medication state | Comparing the PSD/CFC of the primary and secondary outcomes averaged across all FOG episodes to typical gait performance during optimal ON medication state (1 hour post-medication intake) | During walking protocol (duration 15-20 minutes) |
Inclusion Criteria:
Exclusion Criteria:
Participation in another clinical intervention study*
Acute musculoskeletal or other neurological, psychiatric, or cardiovascular conditions affecting gait or any other medical condition which, in the opinion of the investigator, may prevent the participant from completing the protocol in full
Unable to adhere to assessment procedures leading to missing or unusable data, as determined by the investigators
Not a stable medication scheme for at least 7 days before the assessment.*
Occurrence of any of the following within 3 months prior to informed consent:
Substance abuse that may interfere with the patient's compliance
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People with Parkinson's Disease who self-report to experience FOG more than once a day.
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| Name | Affiliation | Role |
|---|---|---|
| Moran Gilat, PhD | KU Leuven | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Department of rehabilitation sciences | Leuven | 3000 | Belgium |
The datasets could be made available under restricted access after publication of the results, following ethical approval and a data-transfer agreement. GDPR and privacy regulations will be adhered to.
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| ID | Term |
|---|---|
| D010300 | Parkinson Disease |
| D001480 | Basal Ganglia Diseases |
| D001927 | Brain Diseases |
| D009069 | Movement Disorders |
| D019636 | Neurodegenerative Diseases |
| D051346 | Mobility Limitation |
| ID | Term |
|---|---|
| D020734 | Parkinsonian Disorders |
| D002493 | Central Nervous System Diseases |
| D009422 | Nervous System Diseases |
| D000080874 | Synucleinopathies |
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| Cross-frequency coupling between beta and theta frequency bands | The averaged cross-frequency coupling (CFC) between the beta (12-25 Hz) and theta (4-7 Hz) frequency bands as measured over the motor and prefrontal cortices during freezing of gait (FOG) episodes compared to typical gait performance in the same individual with Parkinson's disease as measured during different walking trajectories in the home setting. | During walking protocol (duration 15-20 minutes) |
| Power spectral density (Watts/hertz) and cross-frequency coupling (CFC) of beta and theta frequencies bands over other cortical areas. | The averaged power spectral density (PSD) of the beta (12-25 Hz) and theta (4-7 Hz) frequency band measured over other cortical areas (prefrontal, motor, temporal, parietal, visual) during freezing of gait (FOG) episodes compared to typical gait performance in the same individual with Parkinson's disease as measured during different walking trajectories in the home setting. | During walking protocol (duration 15-20 minutes) |
| Power spectrum density and cross-frequency coupling in OFF medication state |
Comparing the PSD/CFC of the primary and secondary outcomes averaged across all FOG episodes to typical gait performance during the practically defined OFF medication state (after minimal 12 hours overnight withdrawal). |
| During walking protocol (duration 15-20 minutes) |
| Comparing the Power spectrum density and cross-frequency coupling in ON and OFF medication state | Comparing the PSD/CFC averaged across all FOG episodes compared to typical gait performance between OFF and ON medication states | During walking protocol (duration 15-20 minutes) |
| Comparing the Power spectrum density and cross-frequency coupling between different FOG manifestations | Comparing the averaged PSD/CFC between the different FOG manifestations (Akinetic vs. Kinetic FOG trembling vs. Kinetic non-trembling vs. Kinetic-festination) in the ON and OFF medication states. | During walking protocol (duration 15-20 minutes) |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |