Identifying the neural correlates of doorway freezing in Parkinson's disease

Elie Matar, James M. Shine, Moran Gilat, Kaylena A. Ehgoetz Martens, Philip B. Ward, Michael J. Frank, Ahmed A. Moustafa, Sharon L. Naismith, Simon J.G. Lewis*

*Corresponding author for this work

Research output: Contribution to journalArticleResearchpeer-review

39 Citations (Scopus)


Freezing of gait (FOG) in Parkinson's disease (PD) is frequently triggered upon passing through narrow spaces such as doorways. However, despite being common the neural mechanisms underlying this phenomenon are poorly understood. In our study, 19 patients who routinely experience FOG performed a previously validated virtual reality (VR) gait paradigm where they used foot-pedals to navigate a series of doorways. Patients underwent testing randomised between both their “ON” and “OFF” medication states. Task performance in conjunction with blood oxygenation level dependent (BOLD) signal changes between “ON” and “OFF” states were compared within each patient. Specifically, as they passed through a doorway in the VR environment patients demonstrated significantly longer “footstep” latencies in the OFF state compared to the ON state. As seen clinically in FOG this locomotive delay was primarily triggered by narrow doorways rather than wide doorways. Functional magnetic resonance imaging revealed that footstep prolongation on passing through doorways was associated with selective hypoactivation in the presupplementary motor area (pSMA) bilaterally. Task-based functional connectivity analyses revealed that increased latency in response to doorways was inversely correlated with the degree of functional connectivity between the pSMA and the subthalamic nucleus (STN) across both hemispheres. Furthermore, increased frequency of prolonged footstep latency was associated with increased connectivity between the bilateral STN. These findings suggest that the effect of environmental cues on triggering FOG reflects a degree of impaired processing within the pSMA and disrupted signalling between the pSMA and STN, thus implicating the “hyperdirect” pathway in the generation of this phenomenon.

Original languageEnglish
Pages (from-to)2055-2064
Number of pages10
JournalHuman Brain Mapping
Issue number7
Publication statusPublished - May 2019
Externally publishedYes


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