Use of Magnetic Resonance Tractography in Detecting Specific Features of the Impairment of Conduction Pathways and Their Prognostic Value in Parkinson’s Disease Complicated by Freezing of Gait

The aim of the study was to determine the localization of conductive pathways in patients with Parkinson’s disease (PD) complicated with freezing of gait, by using data from magnetic resonance tractography, and to identify the prognostic value of these pathways in predicting the course of the disease.

Materials and Methods. 78 patients with idiopathic PD were examined and divided into two groups: patients with freezing of gait (n=31) and without freezing of gait (n=47). The protocol of the investigation consisted of clinical evaluation of the condition of the patients to determine the stage of the disease, and the use of a Siemens MRI Device (magnetic induction field, 1.5 T) to obtain standard images of the coronary, axial and sagittal planes, as well as MRI-protocols of the T1 gradient echo, plus diffusion-tensor tractography with further analysis of the findings with FreeSurfer software.

Results. The groups of patients showed statistically significant differences in the levels of the tract length, diffusivity and fractional anisotropy in the anterior thalamic radiations of both sides, the temporal area of the superior longitudinal fascicle on the left, the parietal area of the superior longitudinal fascicle on the right, and the corticospinal tract on the right. Analysis of the correlative tractographic values with the total scores on the walk-and-balance scale revealed that the highest prognostic value in the development of freezing of gait pertained to damage to the thalamo-frontal tract. A reduction in the value of the maximum voxel length to 80.0 or below, increased the risk of development of freezing of gait in 10 times.

Conclusion. The results demonstrate the involvement of conduction pathways in the mechanisms leading to freezing of gait in PD. Early diagnosis and prediction of the development of this complication using magnetic resonance tractography can indicate the need to adjust the medical treatment and to develop an appropriate special system of rehabilitation.

1. Damulin I.V., Pavlova A.I. Dementia of frontal type. Nevrologicheskiy zhurnal 1997; 1: 37–42.
2. Damulin I.V., Zhuchenko T.D., Levin O.S. Narushenie ravnovesiya i pokhodki u pozhilykh. V kn.: Dostizheniya v neyrogeriatrii. T. 1 [Balance and gait disorders in elderly people. In: Achievements in neurogeriatrics. Vol. 1] Pod red. Yakhno N.N., Damulina I.V. [Yakhno N.N., Damulin I.V. (editors)]. Moscow; 1995; p. 71–97.
3. Levin O.S. Narusheniya khod’by: mekhanizmy, klassifikatsiya, printsipy diagnostiki i lecheniya. V kn.: Ekstrapiramidnye rasstroystva [Gait disorders: mechanisms, classification, and principles of diagnosis and treatment. In: Extrapyramidal disorders]. Pod red. Shtoka V.N., Ivanovoy-Smolenskoy I.A., Levina O.S. [Shtoka V.N., Ivanova-Smolenskaya I.A., Levin O.S. (editors)]. Moscow; 2002; p. 473–494.
4. Levin O.S., Yunishchenko N.A., Skvortsov D.V. Kliniko-instrumental’nyy analiz khod’by i postural’noy neustoychivosti pri bolezni Parkinsona. V kn.: Materialy VII Mezhdunarodnoy konferentsii “Sovremennye tekhnologii vosstanovitel’noy meditsiny” [Clinical-instrumental analysis of gait and postural instability in Parkinson’s disease. In: Materials of the VII International Conference “Modern technology in rehabilitation medicine”]. Sochi; 2004; p. 15–18.
5. Bartels A.L., Balash Y., Gurevich T., Schaafsma J.D., Hausdorff J.M., Giladi N. Relationship between freezing of gait (FOG) and other features of Parkinson’s: FOG is not correlated with bradykinesia. J Clin Neurosci 2003; 10(5): 584–588, https://doi.org/10.1016/S0967-5868(03)00192-9
6. Grossi D., Trojano L., Pellecchia M.T., Amboni M., Fragassi N.A., Barone P. Frontal dysfunction contributes to the genesis of hallucinations in non-demented Parkinsonian patients. Int J Geriatr Psychiatry 2005; 20(7): 668–673, https://doi.org/10.1002/gps.1339.
7. Ito K., Nagano-Saito A., Kato T., Arahata Y., Nakamura A., Kawasumi Y., Hatano K., Abe Y., Yamada T., Kachi T., Brooks D.J. Striatal and extrastriatal dysfunction in Parkinson’s disease with dementia: a 6-[18F]fluoro-L-dopa PET study. Brain 2002; 125 (Pt 6): 1358–1365, https://doi.org/10.109 3/brain/awf134.
8. Trufanov A.G., Odinak M.M., Litvinenko I.V., Rezvantsev M.V., Voronkov L.V. Early diagnosis of dementia with the help of MR-morphometry in patients with Parkinson’s disease. Voenno-meditsinskiy zhurnal 2013; 334(9): 29–34.
9. Litvinenko I.V. Dementia and psychotic disorders in parkinsonism: common origin and new perspectives in therapy. Uspekhi gerontologii 2004; 13: 94–101.
10. Litvinenko I.V., Mikhailenko A.A., Trufanov A.G., Anoshina E.A., Ilyinskiy N.S. Neuroimaging basement of pathological reflexes in 2–3 stages (Hoehn, Yahr scale) of Parkinson disease. Vestnik Rossiyskoy voenno-meditsinskoy akademii 2012; 4(40): 116–120.
11. Trufanov A.G., Litvinenko I.V., Efimtsev A.Yu. The anatomical brain pathways affection in advanced 2–3 stages (Hoehn, Yahr scale) of Parkinson disease. Vestnik Rossiyskoy voenno-meditsinskoy akademii 2012; 4(40): 36–41.
12. Litvinenko I.V., Khalimov R.R., Trufanov A.G., Krasakov I.V., Haimov D.A. New approach to gait disorders therapy in late stages of Parkinson’s disease. Uspekhi gerontologii 2012; 25(2): 267–274.

Trufanov A.G., Khalimov R.R., Yurin A.A., Litvinenko I.V. Use of Magnetic Resonance Tractography in Detecting Specific Features of the Impairment of Conduction Pathways and Their Prognostic Value in Parkinson’s Disease Complicated by Freezing of Gait. Sovremennye tehnologii v medicine 2016; 8(4): 178, https://doi.org/10.17691/stm2016.8.4.22