Brain Changes In Parkinson’s Disease With Freezing Of Gait:A DTI Study Using Voxel Based Analysis

Objective:Freezing of gait(FOG)is a common and disabling gait disorder in Parkinson’s disease.It is defined as the occurrence of a short,occasional that lack or significant reduction in the progress of walking,which is likely to result in falls,trauma,depression,and seriously affect the quality of life and social function of patients.The pathophysiological mechanism of FOG is still not clear.This study will use the voxel based analysis(VBA)method to study the whole brain data of patients with FOG,to find out the abnormal brain structure,and further explore the application value of VBA method,and the possible pathophysiological mechanisms of freezing gait.Methods:A total of 43 patients with Parkinson’s disease diagnosed in Guangdong General Hospital from January 2014 to 2016 were enrolled in this study.There were 20 cases of freezing of gait and 20 cases of non-FOG in patients with Parkinson’s disease.20 age and sex matched healthy control subjects were recruited.All patients with Parkinson’s disease were stopped with drugs for at least 12 hours in order to reduce the effects of pharmacological actions of anti-Parkinson drugs for the neurological activity in patients.The unified Parkinson Disease Rating Scale(UPDRS)score,Hoehn&Yahr staging,and the Mini Mental State Scale(MMSE)score were used.We use GE 3.0 T(Signa Excite Ⅱ HD)of superconducting magnetic resonance imaging system to scan the whole brain in all subjects.The original data were analyzed by diffusion tensor imaging(DTI)about voxel based analysis,and SPM 8 software was used to analyze the DTI parameters of the 3 sets of data.The difference was statistically significant when P<0.05.The results were showed by XjView software and the paremeters are FA and MD.SPSS software also was used to analyze the clinical data of the 3 sets of data.Results:The MMSE score was the lowest in the FOG group,followed by the non-FOG group,and the highest score in the healthy control group.The course of disease,UPDRS-Ⅲ score and H-Y score of FOG group were higher than that of non-FOG group.Compared with the healthy control group,we found that FA of FOG group was reduced in midbrain,left thalamus,left insula,left middle occipital gyrus,right hippocampus,right cuneus,and MD of FOG group are increased in bilateral parahippocampal gyrus,bilateral insula,bilateral medial frontal gyrus,right cingulate gyrus,left superior frontal gyrus,left thalamus,left postcentral gyrus,left caudate nucleus,bilateral superior temporal gyrus,left cuneus,right inferior temporal gyrus.Compared with non-FOG group,we found that FA of FOG group was reduced in left insula,and MD of FOG group are increased in the bilateral superior temporal gyrus,bilateral parahippocampal gyrus,hippocampus,bilateral medial frontal gyrus,precentral gyrus,left inferior frontal gyrus,right inferior frontal gyrus,left cingulate gyrus,right anterior cingulate gyrus,right superior frontal gyrus,right middle frontal gyrus,left inferior temporal gyrus,uncus,right middle temporal gyrus,the right amygdala.Compared with the healthy control group,we found that FA of non-FOG group was reduced in left middle occipital gyrus and right frontal lobe,and MD of non-FOG group are increased in the second half of the right cerebellum and right fusiform gyrus.Conclusion:Our study found that patients with freeing of gait had longer course,more severe cognitive impairment,and more severe clinical symptoms.We study the brain structure in patients with Parkinson’s disease by using voxel based analysis,found that there was a wide range of changes in brain structure in patients with FOG.The structural abnormalities of the brain in bilateral frontal lobe,temporal lobe,Visual occipital lobe,Cortico-basal ganglia-thalamic pathway and limbic system are closely related to the occurrence of FOG.This simple,noninvasive method through the FA and MD parameters change reveals brain abnormalities in patients with Parkinson’s disease of FOG,providing imaging evidence for the pathophysiological mechanism about motor and motor symptoms non motor symptoms in patients with FOG.