New Insights into Freezing of Gait in Parkinson's Disease from Spectral Dynamic Causal Modeling

BackgroundFreezing of gait is one of the most disturbing motor symptoms of Parkinson's disease (PD). However, the effective connectivity between key brain hubs that are associated with the pathophysiological mechanism of freezing of gait remains elusive.ObjectiveThe aim of this study was to identify effective connectivity underlying freezing of gait.MethodsThis study applied spectral dynamic causal modeling (DCM) of resting‐state functional magnetic resonance imaging in dedicated regions of interest determined using a data‐driven approach.ResultsAbnormally increased functional connectivity between the bilateral dorsolateral prefrontal cortex (DLPFC) and the bilateral mesencephalic locomotor region (MLR) was identified in freezers compared with nonfreezers. Subsequently, spectral DCM analysis revealed that increased top‐down excitatory effective connectivity from the left DLPFC to bilateral MLR and an independent self‐inhibitory connectivity within the left DLPFC in freezers versus nonfreezers (>99% posterior probability) were inversely associated with the severity of freezing of gait. The lateralization of these effective connectivity patterns was not attributable to the initial dopaminergic deficit nor to structural changes in these regions.ConclusionsWe have identified novel effective connectivity and an independent self‐inhibitory connectivity underlying freezing of gait. Our findings imply that modulating the effective connectivity between the left DLPFC and MLR through neurostimulation or other interventions could be a target for reducing freezing of gait in PD. © 2024 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.