Understanding Freezing of Gait Using Brain Signals and Virtual Reality

The pathophysiology of FOG is poorly understood, likely contributing to disappointing results of novel neuromodulation strategies. The goal of this study is to identify electrophysiological mechanisms of FOG that can serve as biomarkers for novel neuromodulation strategies. Activity in the globus pallidus internus (GPi), the major output nucleus of the basal ganglia, is central to understanding basal ganglia contributions to gait impairment, as it provides insights into activity that downstream locomotor circuits read out from the basal ganglia. The project leverages a state-of-the-art multimodal brain/behavior recording platform and recent advances in sensing deep brain stimulation devices to record neural activity from the human GPi simultaneously with electroencephalography (EEG), motion capture and eye gaze during over-ground walking and FOG episodes in PD patients with and without FOG. To reliably elicit FOG episodes and improve external validity, the investigators implement a novel immersive virtual reality environment to recapitulate real-world scenarios that commonly trigger FOG. With these tools, the proposed studies will determine how gait-related neural oscillations in the beta (12-30 Hz) and theta/alpha (4-12 Hz) bands in the GPi and cortex relate to abnormal gait during continuous walking (Aim 1); the onset and recovery from FOG episodes (Aim 2); and the therapeutic benefits from external cues (Aim 3). This paves the way for multiple innovative neuromodulation strategies that (1) prevent FOG episodes by promoting normal or compensatory gait control during continuous walking and (2) ameliorate severity of FOG episodes by targeting signals associated with FOG onset and recovery. Additionally, it establishes a novel VR paradigm for future precision-medicine approaches to FOG therapeutic development.