Practical approach to freezing of gait in Parkinson's disease

Abstract

Freezing of gait in Parkinson's disease and related disorders is common and very disabling. It usually occurs in the advanced stages, although mild forms may develop earlier. Freezing can occur on turning, in narrow spaces, immediately before reaching a destination, and in stressful situations. Dual tasking (motor or cognitive load) aggravates the problem. Freezing of gait in Parkinson's disease usually occurs in the 'off' rather than in the 'on' state. It is, therefore, not entirely drug-resistant; the first step in medical treatment is to ensure adequate dopaminergic stimulation to reduce the 'off' state. There is no good evidence for any specific drug to alleviate freezing. Visual or auditory cues are very helpful as behavioural therapy. Assistive devices, such as a wheeled walker sometimes help. Deep brain stimulation of the subthalamic nucleus may alleviate freezing in the 'off' state. Because of the complexity of freezing, individual patients need a careful assessment-particularly in relation to motor fluctuation-to optimise their treatment.

Freezing of Gait in Parkinson's Disease: Its Pathophysiology and Pragmatic Approaches to Management

“…The transient interruption to walking in FOG can occur at initiation of gait, during gait (motor block), or in both situations . In addition, the interruptions are usually associated with other motor phenomena.…”

“…Advanced PD is also associated with more severe cognitive deficits, particularly executive dysfunction, and the capacity to multitask becomes more and more impaired . With advanced disease, dyskinesia becomes more prominent and, when present, can disrupt attention‐control processes, making it difficult to use attention adequately …”

Possibilities of non-drug treatment for Parkinson’s disease

“…[31]. Сходные данные получены в результате исследования эффективности ау-дио-и визуальной стимуляции [32]. Значительный эф-фект на «замораживание» ходьбы (редукция на 10%) и бо-лее высокий уровень доказательности были продемон-стрированы в одном из новейших исследований в данной области [10].…”

Diagnostik und Therapie von „Freezing of Gait“ bei Patienten mit Morbus Parkinson

“…Einige Autoren diskutieren die Einordnung von Festination in die Kategorie der kleinen Schritte vorwärts des FOG [10]. Freezing-of-Gait-Erkrankungen, die mit FOG assoziiert sein können [16] Parkinson-Syndrome -Idiopathisches Parkinson-Syndrom (IPS)…”