Objective: Early analysis to evaluate changes in gait parameters as assessed on standardized and ecological conditions and their association to markers of disease progression, i.e., clinical scales and MRI.

Background: The main challenge for clinician remains to distinguish atypical parkinsonian syndromes (APS) from PD at an early stage. MSA is the most frequent atypical parkinsonian syndrome in the population. It seems to be characterized by more severe and rapidly progressing gait disorders than PD. MSA is a parkinsonian syndrome (Parkinson plus severe and early dysautonomia). Unsupervised mobility assessment technologies coupled with several other biomarkers (clinical and MRI) appeared to be the ideal combination for diagnosis prediction and specific care elaboration.

Method: Gait’N’Park study is a multi-cohort study that aims to investigate prospectively the evolution of gait disorders in extrapyramidal syndromes. In this interim analysis, a sample of 15 MSA patients and a control group of 15 early PD patients (confirmed by DATscan) with less than 3 years of evolution was included.
Gait analysis was performed with connected insoles, on 6 minutes walking test and in real life conditions, at home, during 10 days, at baseline, 12 and 24 weeks. Several parameters were recorded, such as gait velocity, cadence, stride length, stride, stance and swing durations. All patients underwent a brain 3T MRI at baseline and MSA group repeated examination at 24 weeks with anatomical 3D T1-weigthed sequence for volumetric analysis, T2 multiecho sequence for iron quantification and DTI for FA and MD analysis in several regions of interest.

Results: We observed that gait velocity and stride length were more severely altered in MSA than in PD. MRI analysis showed greater atrophy of putamen, cerebellum, brainstem, midbrain and pons in MSA than in PD patients. No difference was found in brain iron overload between groups or at 6 months versus baseline in MSA group. DTI data showed decreased FA values and increased MD values in cerebellum white matter as well as pons in MSA compared with PD.

Conclusion: Analysis of gait parameters using connected insoles combined with MRI data is promising approach to improve diagnosis precision and differentiation of early stage PD and MSA. This could help to provide a better sensibility to improve future clinical trial design.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/preliminary-data-on-multimodal-approach-for-early-characterization-of-parkinsons-disease-pd-and-multiple-system-atrophy-msa-a-prospective-study-with-connected-insoles/