Journal of Movement Disorders

Original Articles

Connectivity-Based Analysis of the Stimulation Effects of Globus Pallidus Interna Deep Brain Stimulation in Parkinson’s Disease: A Focus on Freezing of Gait: Sungyang Jo, Moongwan Choi, Jihyun Lee, Sangjin Lee, Hwon Heo, Chong Hyun Suh, Woo Hyun Shim, Junhyung Kim, Sang Ryong Jeon, Hyunna Lee, Sun Ju Chung; J Mov Disord. 2025;18(4):327-336. Published online July 30, 2025; DOI: https://doi.org/10.14802/jmd.25005

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Objective
Freezing of gait (FOG) significantly affects quality of life and increases the risk of falls in patients with Parkinson’s disease (PD). Although deep brain stimulation (DBS) of the globus pallidus interna (GPi) is effective in managing motor complications, its efficacy in treating FOG remains inconsistent. This study aimed to determine whether preoperative structural brain connectivity can predict both the presence of FOG and its postoperative improvement following GPi DBS.
Methods
We retrospectively analyzed 58 patients with PD who underwent GPi DBS. Preoperative diffusion tensor imaging was used to assess structural connectivity between the volume of activated tissue (VAT) and 82 cortical regions. Machine learning models were developed to predict baseline FOG and postoperative FOG improvement (defined as a ≥1- or ≥2-point reduction) using demographic and connectivity features.
Results
Machine learning models incorporating structural connectivity features between the VAT and cortical regions—including the prefrontal, cingulate, and premotor cortices—outperformed models based solely on demographic variables in predicting both the presence of preoperative FOG and postoperative improvement. For example, the support vector machine model to predict FOG improvement (≥1-point improvement) achieved an accuracy of 0.65 with demographic data alone, which increased to 0.77 with the addition of structural connectivity features. Similar performance enhancements were observed in sensitivity analyses using stricter FOG thresholds (≥2-point improvement).
Conclusion
Preoperative structural connectivity between the GPi and key cortical regions involved in cognitive control and motor planning predicts FOG responsiveness to DBS. These results highlight the utility of connectomic biomarkers for personalizing DBS strategies and optimizing therapeutic outcomes in patients with advanced PD.

Citations

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Predictors of motor outcome with pallidal stimulation for Parkinson’s disease from the CSP468 cohort
Shawn D’Souza, Aashish Batheja, Jeffrey Chen, Harsh P. Shah, Vikram Seshadri, Nina Opem, Omar Al-Dulaimi, Jamie Toms, Pierre D’Haese, Benoit M. Dawant, Rui Li, Paul Koch, Paul Larson, Kathryn L. Holloway
npj Parkinson's Disease.2026;[Epub] CrossRef

Association of Depression With Early Occurrence of Postural Instability in Parkinson’s Disease: Yun Su Hwang, Sungyang Jo, Kye Won Park, Seung Hyun Lee, Sangjin Lee, Sun Ju Chung; J Mov Disord. 2023;16(1):68-78. Published online December 20, 2022; DOI: https://doi.org/10.14802/jmd.22091

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Abstract PDF Supplementary Material

Objective
Depression in Parkinson’s disease (PD) affects the quality of life of patients. Postural instability and gait disturbance are associated with the severity and prognosis of PD. We investigated the association of depression with axial involvement in early-stage PD patients.
Methods
This study involved 95 PD patients unexposed to antiparkinsonian drugs. After a baseline assessment for depression, the subjects were divided into a depressed PD group and a nondepressed PD group. Analyses were conducted to identify an association of depression at baseline with the following outcome variables: the progression to Hoehn and Yahr scale (H-Y) stage 3, the occurrence of freezing of gait (FOG), levodopa-induced dyskinesia, and wearing-off. The follow-up period was 53.40 ± 16.79 months from baseline.
Results
Kaplan–Meier survival curves for H-Y stage 3 and FOG showed more prominent progression to H-Y stage 3 and occurrences of FOG in the depressed PD group than in the nondepressed PD group (log-rank p = 0.025 and 0.003, respectively). Depression in drug-naïve, early-stage PD patients showed a significant association with the progression to H-Y stage 3 (hazard ratio = 2.55; 95% confidence interval = 1.32–4.93; p = 0.005), as analyzed by Cox regression analyses. In contrast, the occurrence of levodopa-induced dyskinesia and wearing-off did not differ between the two groups (log-rank p = 0.903 and 0.351, respectively).
Conclusion
Depression in drug-naïve, early-stage PD patients is associated with an earlier occurrence of postural instability. This suggests shared nondopaminergic pathogenic mechanisms and potentially enables the prediction of early development of postural instability.

Citations

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Efficacy and safety of adjunctive acupuncture for depression and motor symptoms in Parkinson’s disease: study protocol for a randomized controlled trial
Kaihao Liao, Jing-Qi Fan, Liangman Xiao, Danxia Gu, Mingda Han, Jingyu Nian, Shunan Wu, Li-Xing Zhuang
Frontiers in Psychiatry.2026;[Epub] CrossRef
Current Aspects of the Relationship between Depression and Cognitive Impairment in Patients with Parkinson’s Disease
M. R. Nodel
Neuroscience and Behavioral Physiology.2026; 56(3): 542. CrossRef
Association of motor subtype and tremor type with Parkinson's disease progression: An exploratory longitudinal analysis
Yuke Zhong, Huahua Su, Ying Liu, Hang Liu, Guohui Liu, Zhihui Liu, Jiahao Wei, Junyi Wang, Yuchen She, Changhong Tan, Lijuan Mo, Lin Han, Fen Deng, Xi Liu, Lifen Chen
Journal of Parkinson’s Disease.2025; 15(1): 111. CrossRef
Current aspects of the relationship between depression and cognitive impairment in patients with Parkinson’s disease
M.R. Nodel
S.S. Korsakov Journal of Neurology and Psychiatry.2025; 125(10): 66. CrossRef
Noisy galvanic vestibular stimulation and static balance in parkinson’s disease: a multimodal resting‑state fMRI feasibility study
Yun Su Hwang, Jihwan Min, Yongseon Yoo, Jin-Ju Kang, Marianne Dieterich, Seung-Bae Hwang, Jong-Min Lee, Sun-Young Oh
Journal of NeuroEngineering and Rehabilitation.2025;[Epub] CrossRef

Case Report

Focused Vibrotactile Stimulation with Cueing Effect on Freezing of Gait in Parkinson’s Disease: Two Case Reports: Xiu Sheng Tan, Floyd Pierres, Alex Dallman-Porter, William Hardie-Brown, Kyum-Yil Kwon; J Mov Disord. 2021;14(3):236-238. Published online September 8, 2021; DOI: https://doi.org/10.14802/jmd.21076

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Abstract PDF Supplementary Material

Freezing of gait (FOG) is a common occurrence in patients with Parkinson’s disease (PD) that leads to significant limitations in mobility and increases risk of falls. Focused vibrotactile stimulation and cueing are two methods used to alleviate motor symptoms, including FOG, in patients with PD. While effective on their own, the effect of combining both focused vibrotactile stimulation and cueing has yet to be investigated. Two patients, both with a history of PD, suffered from frequent FOG episodes that failed to respond adequately to medication. A novel vibrotactile stimulation device that delivered rhythmic kinesthetic stimuli onto the sternum successfully reduced FOG episodes in both patients and drastically improved their mobility as measured by the Timed Up and Go test. We found that a combination of focused vibrotactile stimulation and cueing was effective in reducing FOG episodes in two patients with PD. Further well-designed prospective studies are needed to confirm our observations.

Citations

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Identification of anatomical locations: its relevance for vibrotactile perception of individuals with Parkinson's disease
Ankita Raghuvanshi, Priya Pallavi, Rahul Chhatlani, Jayesh Parmar, Manish Rana, Sagar Betai, Uttama Lahiri
BioMedical Engineering OnLine.2025;[Epub] CrossRef
A pilot interventional study on feasibility and effectiveness of the CUE1 device in Parkinson's disease
Viktoria Azoidou, Kira Rowsell, Ellen Camboe, Kamalesh C. Dey, Alexandra Zirra, Corrine Quah, Thomas Boyle, David Gallagher, Alastair J. Noyce, Cristina Simonet
Parkinsonism & Related Disorders.2025; 133: 107349. CrossRef
Non-invasive device to alleviate symptoms in people living with Parkinson’s: study protocol for a multicentre phase II double-blind randomised controlled trial
Viktoria Azoidou, Essa Bhadra, Kira Rowsell, Ellen Camboe, Kamalesh Dey, Alexandra Zirra, Corrine Quah, Caroline Budu, Thomas Boyle, David Gallagher, Alastair Noyce, Cristina Simonet
BMJ Open.2025; 15(4): e096051. CrossRef
A literature review on vibrotactile stimulation devices for individuals with Parkinson's disease
S.M. Tiell, B.L. Davis
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Elham Ghazizadeh, Zahra Naseri, Hans-Peter Deigner, Hossein Rahimi, Zeynep Altintas
Frontiers in Medicine.2024;[Epub] CrossRef
The effect of tactile cueing on dual task performance in Parkinson’s disease. A systematic review and meta-analysis
Viktoria Azoidou, Alastair J Noyce, Cristina Simonet
Clinical Parkinsonism & Related Disorders.2024; 11: 100284. CrossRef
Tapping into tissue bioelectromechanics: Electroactive biopolymers for dynamic tissue engineering
Matthew K. Burgess, Malavika Nair
APL Materials.2024;[Epub] CrossRef
Therapeutic Devices for Motor Symptoms in Parkinson’s Disease: Current Progress and a Systematic Review of Recent Randomized Controlled Trials
Joji Fujikawa, Ryoma Morigaki, Nobuaki Yamamoto, Teruo Oda, Hiroshi Nakanishi, Yuishin Izumi, Yasushi Takagi
Frontiers in Aging Neuroscience.2022;[Epub] CrossRef
Exploring a New Cueing Device in People Who Experience Freezing of Gait: Acceptance of a Study Design
Agnes Wilhelm, Tanja Riedl, Christian Paumann, Jessie Janssen, Hélio Teive
Parkinson's Disease.2022;[Epub] CrossRef
Technological support for people with Parkinson’s disease: a narrative review
Tommaso Di Libero, Elisa Langiano, Chiara Carissimo, Maria Ferrara, Pierluigi Diotaiuti, Angelo Rodio
Journal of Gerontology and Geriatrics.2022; : 1. CrossRef
Future Therapeutic Strategies for Freezing of Gait in Parkinson’s Disease
Cathy K. Cui, Simon J. G. Lewis
Frontiers in Human Neuroscience.2021;[Epub] CrossRef

Original Article

Heterogeneous Patterns of Striatal Dopamine Loss in Patients with Young- versus Old-Onset Parkinson’s Disease: Impact on Clinical Features: Seok Jong Chung, Han Soo Yoo, Yang Hyun Lee, Phil Hyu Lee, Young H. Sohn; J Mov Disord. 2019;12(2):113-119. Published online May 30, 2019; DOI: https://doi.org/10.14802/jmd.18064

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Abstract PDF Supplementary Material

Objective
Ample evidence has suggested that age at onset of Parkinson’s disease (PD) is associated with heterogeneous clinical features in individuals. We hypothesized that this may be attributed to different patterns of nigrostriatal dopamine loss.
Methods
A total of 205 consecutive patients with de novo PD who underwent 18F-FP-CIT PET scans (mean follow-up duration, 6.31 years) were divided into three tertile groups according to their age at onset of parkinsonian motor symptoms. Striatal dopamine transporter (DAT) availability was compared between the old- (n = 73) and young-onset (n = 66) groups. In addition, the risk of developing freezing of gait (FOG) and longitudinal requirements for dopaminergic medications were examined.
Results
The old-onset PD group (mean age at onset, 72.66 years) exhibited more severe parkinsonian motor signs than the young-onset group (52.58 years), despite comparable DAT availability in the posterior putamen; moreover, the old-onset group exhibited more severely decreased DAT availability in the caudate than the young-onset group. A Cox regression model revealed that the old-onset PD group had a higher risk for developing FOG than the young-onset group [hazard ratio 2.523, 95% confidence interval (1.239–5.140)]. The old-onset group required higher doses of dopaminergic medications for symptom control than the young-onset group over time.
Conclusion
The present study demonstrated that the old-onset PD group exhibited more severe dopamine loss in the caudate and were more likely to develop gait freezing, suggesting that age at onset may be one of the major determinants of the pattern of striatal dopamine depletion and progression of gait disturbance in PD.

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Spatiotemporal Progression Patterns of Striatal Dopamine Depletion and Cerebral Hypoperfusion in Parkinson's Disease
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Dissecting divergent outcomes in stem cell-derived dopamine cell therapy trials for Parkinson’s disease
Chan Wook Park, Sanghyun Park, Seok Jong Chung, Phil Hyu Lee, Dong-Wook Kim
Cell Stem Cell.2026;[Epub] CrossRef
Identifying brain degeneration patterns in early-stage Parkinson’s disease: a multimodal MRI study
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