Normal and pathological gait: what we learn from Parkinson's disease

Area of Science:

• Neuroscience
• Movement Disorders
• Neurology

Background:

• Gait and balance disorders are significant challenges in Parkinson's disease (PD).
• These motor symptoms often show poor response to dopaminergic therapy, especially in later disease stages.
• Current treatments are limited, with rehabilitation being the primary approach.

Purpose of the Study:

• To comprehensively describe the clinical features of gait and balance disorders in PD.
• To highlight the brain networks involved in gait and balance control relevant to PD.
• To review potential pathophysiological mechanisms and future therapeutic avenues.

Main Methods:

• Review of clinical features of gait and balance deficits in Parkinson's disease.
• Analysis of neuroanatomical and functional brain networks involved in locomotion and balance.
• Synthesis of current research on non-dopaminergic pathways implicated in PD gait disorders.
• Review of functional neurosurgery and emerging therapeutic strategies.

Main Results:

• Gait and balance impairments in PD are complex and may involve extradopaminergic lesions.
• Key brain structures include the mesencephalic locomotor region, noradrenergic and serotoninergic systems, cerebellum, and cortex.
• Evidence suggests functional neurosurgery is being explored for gait disorders.

Conclusions:

• Gait and balance disorders in PD likely involve multiple neurotransmitter systems and brain regions beyond the dopaminergic system.
• Understanding these extradopaminergic pathways is crucial for developing effective treatments.
• Future research should focus on novel therapeutic targets and advanced interventions like functional neurosurgery.