Category: Parkinson's Disease: Disease mechanisms
Objective: To characterize the neural signature of Freezing of gait (FOG) in Parkinson’s disease (PD) across multiple types of triggers.
Background: FOG is among the most disabling, least understood, and poorly treated symptoms of PD. Novel deep brain stimulation devices (adaptive-DBS, aDBS) provide new potential for effectively treating FOG as they sense neural signals in real time and provide stimulation in response to patient-specific pathological neural activity. A key barrier to using adaptive DBS for FOG treatment is the limited understanding of the underlying subthalamic nucleus (STN) activity related to FOG as acquiring neural signals during FOG events is challenging. FOG triggers are multi-factorial, vary between individuals, and are difficult to elicit in clinical settings. The Cleveland Clinic – Virtual Home Environment (CC-VHE) Platform was developed to address these challenges by combining an omnidirectional treadmill with immersive virtual reality (VR) environments to induce FOG under three global scenarios. The three scenarios included emotional (Anxiety module), cognitive (Dual-task module), and physical (Physical module) triggers to elicit FOG and identify underlying similarities and differences in STN activity as a function of scenario.
Method: Local field potential recordings (LFPs) were collected continuously from eight individuals with PD with the Percept DBS system (Medtronic, PLC), with leads placed bilaterally in the STN while the participant completed the three CC-VHE modules.
Results: Participants with PD experienced a total of 167 FOG events with a total freeze duration of 1028 s. Combining STN-LFP data across all modules revealed that alpha-beta band power (8-30 Hz) was elevated by 28% (p<0.05) during FOG compared to walking. Post-hoc pairwise comparison revealed significant increases in the alpha-beta power during FOG compared to walking in each module with the Dual-task module demonstrating the largest increase (41%, p<0.01) followed by the Anxiety (24%, p<0.01) and Physical (23%, p<0.01) module, resulting in a significant difference between the Dual-task and Physical alpha-beta power (p<0.01).
Conclusion: Significant differences in the increase in alpha-beta band power between the modules during FOG suggest that the neural signature of FOG varies based on the environmental stimuli. Identifying the unique neural signatures underlying FOG will advance its treatment.
To cite this abstract in AMA style:
M. Miller Koop, A. Rosenfeldt, K. Scelina, L. Scelina, C. Waltz, A. Bazyk, V. Berki, K. Baker, N. Malan, S. Nagel, B. Walter, J. Liao, K. Baker, J. Alberts. Characterizing the Neural Signature of Parkinsonian Freezing of Gait During an Immersive Virtual Reality Paradigm [abstract]. Mov Disord. 2025; 40 (suppl 1). https://www.mdsabstracts.org/abstract/characterizing-the-neural-signature-of-parkinsonian-freezing-of-gait-during-an-immersive-virtual-reality-paradigm/. Accessed October 5, 2025.« Back to 2025 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/characterizing-the-neural-signature-of-parkinsonian-freezing-of-gait-during-an-immersive-virtual-reality-paradigm/