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

J Neurol Neurosurg Psychiatry. 2012 Oct;83(10):979-85. doi: 10.1136/jnnp-2012-302263. Epub 2012 Jun 29.

Abstract

Gait and balance disorders represent a major therapeutic challenge in Parkinson's disease (PD). These symptoms respond poorly to dopaminergic treatments, except in the early phase of the disease. Currently, no other treatment is particularly efficient and rehabilitation appears to be the most effective approach. Since these gait and balance deficits are resistant to dopaminergic drugs, their occurrence could be related to the development of extradopaminergic lesions in PD patients. We provide a comprehensive description of the clinical features of gait and balance disorders in PD. We also highlight the brain networks involved in gait and balance control in animals and humans with a particular focus on the relevant structures in the context of PD, such as the mesencephalic locomotor region. We also review other neuronal systems that may be involved in the physiopathology of gait and balance disorders in PD (noradrenergic and serotoninergic systems, cerebellum and cortex). In addition, we review recent evidence regarding functional neurosurgery for gait disorders in PD and propose new directions for future therapeutic research.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Accidental Falls*
  • Brain Stem / metabolism
  • Brain Stem / physiopathology
  • Cerebellum / metabolism
  • Cerebellum / physiopathology
  • Cerebral Cortex / metabolism
  • Cerebral Cortex / physiopathology
  • Controlled Clinical Trials as Topic
  • Deep Brain Stimulation*
  • Dopamine / metabolism
  • Epinephrine / metabolism
  • Gait Disorders, Neurologic / etiology
  • Gait Disorders, Neurologic / metabolism
  • Gait Disorders, Neurologic / physiopathology*
  • Gait Disorders, Neurologic / therapy
  • Gait* / physiology
  • Humans
  • Parkinson Disease / complications
  • Parkinson Disease / metabolism
  • Parkinson Disease / physiopathology*
  • Parkinson Disease / therapy
  • Postural Balance*
  • Serotonin / metabolism

Substances

  • Serotonin
  • Dopamine
  • Epinephrine