Freezing of gait: overview on etiology, treatment, and future directions

Falla, Marika; Cossu, Giovanni; Fonzo, Alessio Di

doi:10.1007/s10072-021-05796-w

Cited by 12 publications

(26 citation statements)

References 128 publications

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“…This result was confirmed when the M-H&Y scale was correlated with part II ("Freezing severity") and part III ("Freezing impact on daily life") sub scores. These results are supported by previous studies showing an increased FOG prevalence according to the stage of the disease [20] and are in line with those reported in the validation of FOG-Q in other languages (Italian, Swedish) [14,15].…”

Section: Discussionsupporting

confidence: 92%

“…Finally, when a possible relationship between FOG and motor complications (MDS-UPDRS part IV) was investigated, a significant positive correlation was found. As reported in a recent review, [ 20 ] the “OFF-state” FOG is frequently seen in the stage of early-fluctuations, the “OFF–ON” FOG usually appears with disease progression whereas the so called “Biphasic” FOG [ 27 ] described as Levo-Dopa-induced FOG, emerges in the OFF and ON transition phase. Therefore, it could be assumed that FOG symptoms may be more severe with the emergence of motor fluctuation, and with longer OFF state periods.…”

Section: Discussionmentioning

confidence: 99%

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Assessment of the psychometric properties of the Italian version of the New Freezing of Gait Questionnaire (NFOG-Q-IT) in people with Parkinson disease: a validity and reliability study

et al. 2023

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Introduction Freezing of gait (FOG) in Parkinson’s disease (PD) is a challenging clinical symptom to assess, due to its episodic nature. A valid and reliable tool is the New FOG Questionnaire (NFOG-Q) used worldwide to measure FOG symptoms in PD. Objective The aim of this study was to translate, to culturally adapt, and to test the psychometric characteristics of the Italian version of the NFOG-Q (NFOG-Q-It). Methods The translation and cultural adaptation was based on ISPOR TCA guidelines to finalize the 9-item NFOG-Q-It. Internal consistency was assessed in 181 Italian PD native speakers who experienced FOG using Cronbach’s alpha. Cross-cultural analysis was tested using the Spearman's correlation between the NFOG-Q-It and the Modified Hoehn-Yahr Scale (M-H&Y). To assess construct validity, correlations among NFOG-Q-It, Movement Disorder Society-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS), Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA), the Falls Efficacy Scale-International (FES-I), the 6-min Walking Test (6MWT), the Mini Balance Evaluation System Test (Mini-BESTest) and the Short Physical Performance Battery (SPPB) were investigated. Results The Italian N-FOGQ had high internal consistency (Cronbach’s α = 0.859). Validity analysis showed significant correlations between NFOG-Q-IT total score and M-H&Y scores (r = 0.281 p < 0.001), MDS-UPDRS (r = 0.359 p < 0.001), FES-I (r = 0.230 p = 0.002), Mini BESTest (r = -0.256 p = 0.001) and 6MWT (r = -0.166 p = 0.026). No significant correlations were found with SPPB, MOCA and MMSE. Conclusion The NFOG-It is a valuable and reliable tool for assessing FOG symptoms, duration and frequency in PD subjects. Results provide the validity of NFOG-Q-It by reproducing and enlarging previous psychometric data.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Assessment of the psychometric properties of the Italian version of the New Freezing of Gait Questionnaire (NFOG-Q-IT) in people with Parkinson disease: a validity and reliability study

et al. 2023

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“…These gait disturbances lead to falls 2 . The symptoms are considered to be primarily due to postural dysfunction (bending forward of the trunk), impaired rhythm formation (difficulty in continuing periodic movements), akinesia (decrease in movement amplitude), and a sequence effect (gradual decrease in stride length) caused by different network failures associated with the basal ganglia 3 . However, the relationship between gait disturbances and the physiology of these various functional declines remains unclear 1 – 6 .…”

Section: Introductionmentioning

confidence: 99%

“…Various approaches have been proposed to treat the motor symptoms of Parkinson's disease. In general, drug therapy with levodopa (l-dopa) and surgical treatment with deep brain stimulation are selected based on various factors, including the progression of symptoms, treatment efficacy, side effects, and patient satisfaction 3 , 7 – 9 .…”

Section: Introductionmentioning

confidence: 99%

Gait improvement with wearable cyborg HAL trunk unit for parkinsonian patients: five case reports

Uehara¹,

Kawamoto²,

Imai³

et al. 2023

Sci Rep

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Cybernic treatment involves the generation of an interactive bio-feedback loop between an individual’s nervous system and the worn cyborg Hybrid Assistive Limb (HAL); this treatment has been applied for several intractable neuromuscular disorders. Thus, it is of interest to determine its potential for parkinsonian patients. This study confirmed the feasibility of using a HAL trunk unit to improve parkinsonian gait disturbance. HAL establishes functional and physical synchronization with the wearer by providing lateral cyclic forces to the chest in the form of somatosensory and motor cues. To confirm the feasibility of its use for improving parkinsonian gait disturbances, we conducted experiments with three Parkinson’s disease patients and two patients with progressive supranuclear palsy. During the experiments, the immediate effect of the intervention was assessed; all participants exhibited improvements in gait disturbance while wearing the HAL unit, and this improvement effect persisted without the HAL unit in two participants. Afterward, based on the assessment, we conducted a continuous intervention for one participant. In this intervention, the number of steps in the final experiment was significantly decreased compared with the initial state. These findings suggest that the proposed method is an option for treating parkinsonian patients to generate somatosensory and motor cues.

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“…1,3 The available treatment strategies for FOG are poorly effective, with the conventional dopamine replacement therapy can only partially ameliorate FOG and some characteristics continue to worsen over time. 1,4,5 The clinical observations and researches are mounting that besides the dopaminergic system, non-dopaminergic pathophysiology played a prominent role in regulating balance and gait in PD. 6,7 Emerging evidences have shown that cholinergic dysfunction superimposed on dopaminergic loss could significantly impair motor control for gait and postural functions, thus contribute to FOG.…”

Section: Introductionmentioning

confidence: 99%

Cholinergic basal forebrain atrophy in Parkinson's disease with freezing of gait

Gan

Cao

Wang

et al. 2023

Ann Clin Transl Neurol

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Background: Mounting research support that cholinergic dysfunction plays a prominent role in freezing of gait (FOG), which commonly occurs in Parkinson's disease (PD). Basal forebrain (BF), especially the cholinergic nuclei 4 (Ch4), provides the primary source of the brain cholinergic input. However, whether the degeneration of BF and its innervated cortex contribute to the pathogenesis of FOG is unknown. Objective: To explore the role of structural alterations of BF and its innervated cortical brain regions in the pathogenesis of PD patients with freezing. Methods: Magnetic resonance imaging assessments and neurological assessments were performed on 20 PD patients with FOG (PD-FOG), 20 without FOG (PD-NFOG), and 21 healthy participants. Subregion volumes of the BF were compared among groups. Local gyrification index (LGI) was computed to reveal the cortical alternations. Relationships among subregional BF volumes, LGI, and the severity of FOG were evaluated by multiple linear regression. Results: Our study discovered that, compared to PD-NFOG, PD-FOG exhibited significant Ch4 atrophy (p = 4.6 9 10 À5 ), accompanied by decreased LGI values in the left entorhinal cortex (p = 3.00 9 10 À5 ) and parahippocampal gyrus (p = 2.90 9 10 À5 ). Based on the regression analysis, Ch4 volume was negatively associated with FOG severity in PD-FOG group (b = À12.224, T = À2.556, p = 0.031). Interpretation: Our results imply that Ch4 degeneration and microstructural disorganization of its innervated cortical brain regions may play important roles in PD-FOG.

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Freezing of gait: overview on etiology, treatment, and future directions

Cited by 12 publications

References 128 publications

Assessment of the psychometric properties of the Italian version of the New Freezing of Gait Questionnaire (NFOG-Q-IT) in people with Parkinson disease: a validity and reliability study

Assessment of the psychometric properties of the Italian version of the New Freezing of Gait Questionnaire (NFOG-Q-IT) in people with Parkinson disease: a validity and reliability study

Gait improvement with wearable cyborg HAL trunk unit for parkinsonian patients: five case reports

Cholinergic basal forebrain atrophy in Parkinson's disease with freezing of gait

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