The clinical spectrum of freezing of gait in Parkinson's disease

Abstract

Freezing of gait (FOG) is a common and very disabling symptom in Parkinson's disease (PD). It is usually observed in the advanced stage of the disease, although a mild form can be seen in the early stage. Although some studies have suggested that longer duration of dopaminergic treatment is associated with FOG, the disease progression alone may be responsible for the development of FOG. FOG can be experienced on turning, in narrow spaces, while reaching a destination, and in stressful situations. In PD, FOG is strongly associated with motor fluctuation. FOG is commonly observed in the "off" state and is observed less frequently in the "on" state. Dual tasking (cognitive load) aggravates FOG. Visual or auditory cues often resolve FOG. Analysis of gait revealed that the stepping rhythm suddenly jumps into high frequency (4-5 Hz) in FOG (hastening), and that floor reaction forces are disregulated. Since the hastening phenomenon was also reported in patients with lesions in the striatum and/or the frontal lobe, fronto-basal ganglia projections are considered essential for FOG. Careful observation and gait pattern analysis may lead to a successful management of individual PD patients with FOG.

Movement Initiation-Locked Activity of the Anterior Putamen Predicts Future Movement Instability in Periodic Bimanual Movement

“…In the basal ganglia-thalamocortical circuit, the putamen has been found to disinhibit the thalamus by inhibiting the internal globus pallidus, which facilitates cortical activity via the direct motor pathway (Alexander and Crutcher, 1990). Dysfunction in this circuit causes difficulties in initiating movement, including hesitation associated with gait initiation in Parkinson's disease (Okuma and Yanagisawa, 2008). Our results suggest that more difficult movements transiently activate the anterior putamen to a greater extent than less difficult movements during movement initiation.…”

Regional Gray Matter Atrophy in Patients with Parkinson Disease and Freezing of Gait

“…21,22 Mental loading and divided attention may increase the occurrence of FOG episodes 23 ; however, visual and auditory cues can usually overcome FOG. 24 Furthermore, Helmich et al 25 demonstrated an increased dependence on visual-information processing during a motor imagery task in PD, suggesting that patients with PD increasingly rely on visual cues to control locomotion. 26 Our findings are consistent with previous radiotracer studies demonstrating hypometabolism or hypoperfusion of temporoparietal and occipital cortices in patients with FOG.…”

Independent Regulation of the Cycle and Acceleration in Parkinsonian Gait Analyzed by a Long-Term Daily Monitoring System

“…One possible explanation is that PD patients might improve their walking by making compensatory and conscious efforts in the presence of doctors. Indeed, it has been well known that mild emotional stress could improve the gait disorder when walking was examined in laboratories [7,13,14]. An alternative explanation is that PD patients show a latent gait disorder, which is hardly detected by routine neurological examinations, in the early stage of PD.…”