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Freezing of gait

Federica Agosta, Roberto Gatti, Elisabetta Sarasso, Maria Antonietta Volonté, Elisa Canu, Alessandro Meani, Lidia Sarro, Massimiliano Copetti, Erik Cattrysse, Eric Kerckhofs, Giancarlo Comi, Andrea Falini, Massimo Filippi
Gait disorders represent a therapeutic challenge in Parkinson's disease (PD). This study investigated the efficacy of 4-week action observation training (AOT) on disease severity, freezing of gait and motor abilities in PD, and evaluated treatment-related brain functional changes. 25 PD patients with freezing of gait were randomized into two groups: AOT (action observation combined with practicing the observed actions) and "Landscape" (same physical training combined with landscape-videos observation). At baseline and 4-week, patients underwent clinical evaluation and fMRI...
October 24, 2016: Journal of Neurology
C Schlenstedt, A Shalash, M Muthuraman, D Falk, K Witt, G Deuschl
The aim of this meta-analysis was to summarize the short- and long-term effects of bilateral deep brain stimulation of the subthalamic nucleus (STN-DBS) on gait and freezing of gait (FOG) in Parkinson's disease and to detect predictors of post-stimulation outcome. A comprehensive review of the literature was conducted up to October 2015 using Medline Ovid databases for studies analyzing the effect of bilateral STN-DBS on FOG and/or gait. Sixteen studies with available data for the gait item (no. 29) of the Unified Parkinson's Disease Rating Scale (UPDRS) and six studies with the FOG item (no...
October 20, 2016: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
Julie M Hall, Kaylena A Ehgoetz Martens, Courtney C Walton, Claire O'Callaghan, Peter E Keller, Simon J G Lewis, Ahmed A Moustafa
Parkinson's disease (PD) is a heterogeneous neurological disorder with a variety of motor and non-motor symptoms. The underlying mechanisms of these symptoms are not fully understood. An increased interest in structural connectivity analyses using diffusion tensor imaging (DTI) in PD has led to an expansion of our understanding of the impact of abnormalities in diffusivity on phenotype. This review outlines the contribution of these abnormalities to symptoms of PD including bradykinesia, tremor and non-tremor phenotypes, freezing of gait, cognitive impairment, mood, sleep disturbances, visual hallucinations and olfactory dysfunction...
September 28, 2016: Parkinsonism & related Disorders
Y Lee, D K Lee, J M Lee, S J Chung, J J Lee, Y H Sohn, P H Lee
BACKGROUND AND PURPOSE: Although early cerebellar symptoms are one of the exclusive criteria in the diagnosis of progressive supranuclear palsy (PSP), cerebellar involvement in PSP is evident both clinically and pathologically. However, structural analysis focusing on the cerebellum has not been previously studied in patients with PSP. We aimed to evaluate cerebellar involvement in PSP using a magnetic resonance imaging-based segmental volumetric analysis. METHODS: We retrospectively enrolled 48 patients with PSP composed of 25 patients with PSP-Richardson's syndrome (RS) and 23 patients with pure akinesia with gait freezing, 39 patients with Parkinson's disease (PD) and 34 healthy controls...
October 16, 2016: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
Ken Ikeda, Takehisa Hirayama, Takanori Takazawa, Kiyokazu Kawabe, Yasuo Iwasaki
Objective Parkinson's disease (PD) is characterized by the progressive degeneration of the nigrostriatal dopaminergic neurons. Rotigotine is a non-ergot dopamine receptor agonist (DA). Its transdermal patch maintains the effective concentrations for 24 hours. Freezing of gait (FOG) is a common and devastating symptom in PD patients. Little is known about therapeutic effects of rotigotine on FOG in PD patients. Herein we compared how three non-ergot DAs of rotigotine, pramipexole LA and ropinirole CR influence FOG, besides classical motor deficits in PD patients...
2016: Internal Medicine
Sangwon Han, Minyoung Oh, Jungsu S Oh, Sang Ju Lee, Seung Jun Oh, Sun Ju Chung, Hee Kyung Park, Jae Seung Kim
Importance: Pure akinesia with gait freezing (PAGF) is a clinical syndrome characterized by freezing of gait, handwriting, and speech without abnormal eye movement or cognitive impairment. Several studies have suggested that PAGF may be a variant of progressive supranuclear palsy (PSP). However, the characteristics of striatal dopamine transporter loss in PAGF are unknown. Objective: To investigate the subregional pattern of striatal dopamine transporter loss in patients with PAGF in comparison with patients with PSP and those with Parkinson disease (PD)...
October 10, 2016: JAMA Neurology
Clement Hamani, Tipu Aziz, Bastiaan R Bloem, Peter Brown, Stephan Chabardes, Terry Coyne, Kelly Foote, Edgar Garcia-Rill, Etienne C Hirsch, Andres M Lozano, Paolo A M Mazzone, Michael S Okun, William Hutchison, Peter Silburn, Ludvic Zrinzo, Mesbah Alam, Laurent Goetz, Erlick Pereira, Anand Rughani, Wesley Thevathasan, Elena Moro, Joachim K Krauss
Several lines of evidence over the last few years have been important in ascertaining that the pedunculopontine nucleus (PPN) region could be considered as a potential target for deep brain stimulation (DBS) to treat freezing and other problems as part of a spectrum of gait disorders in Parkinson disease and other akinetic movement disorders. Since the introduction of PPN DBS, a variety of clinical studies have been published. Most indicate improvements in freezing and falls in patients who are severely affected by these problems...
October 11, 2016: Stereotactic and Functional Neurosurgery
Won Hyuk Chang, Min Su Kim, Jin Whan Cho, Jinyoung Youn, Yun Kwan Kim, Sun Woong Kim, Ahee Lee, Yun-Hee Kim
OBJECTIVE: To investigate the potential of cumulative high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) on freezing of gait in atypical Parkinsonism. DESIGN: Randomized, single-blinded, crossover study with a blinded observer. PARTICIPANTS: Eight patients with atypical Parkinsonism. METHODS: All participants received HF-rTMS over the lower leg primary motor cortex (M1-LL) for 5 consecutive days. Alternative sham stimulation was also administered with a 2-week wash-out period...
October 12, 2016: Journal of Rehabilitation Medicine
Claudia Barthel, Elizabeth Mallia, Bettina Debû, Bastiaan R Bloem, Murielle Ursulla Ferraye
BACKGROUND: Freezing of gait (FOG) is a mysterious, complex and debilitating phenomenon in Parkinson's disease. Adequate assessment is a pre-requisite for managing FOG, as well as for assigning participants in FOG research. The episodic nature of FOG, as well as its multiple clinical expressions make its assessment challenging. OBJECTIVE: To highlight the available assessment tools and to provide practical, experience-based recommendations for reliable assessment of FOG...
October 19, 2016: Journal of Parkinson's Disease
Matthew J Georgiades, Moran Gilat, Kaylena A Ehgoetz Martens, Courtney C Walton, Patrick G Bissett, James M Shine, Simon J G Lewis
Freezing of gait (FOG) is a common, disabling symptom of Parkinson's disease (PD) that is associated with deficits in motor initiation and inhibition. Understanding of underlying neurobiological mechanisms has been limited by difficulties in eliciting and objectively characterizing such gait phenomena in the clinical setting. However, recent work suggests that virtual reality (VR) techniques might offer the potential to study motor control. This study utilized a VR paradigm to explore deficits in motor initiation and stopping performance, including stop failure in PD patients with (Freezers, 31) and without (Non-Freezers, 23) FOG, and healthy age-matched Controls (15)...
September 17, 2016: Neuroscience
Anke H Snijders, Kaoru Takakusaki, Bettina Debu, Andres M Lozano, Vibhor Krishna, Alfonso Fasano, Tipu Z Aziz, Stella M Papa, Stewart A Factor, Mark Hallett
Freezing of gait (FOG) is a common and debilitating, but largely mysterious, symptom of Parkinson disease. In this review, we will discuss the cerebral substrate of FOG focusing on brain physiology and animal models. Walking is a combination of automatic movement processes, afferent information processing, and intentional adjustments. Thus, normal gait requires a delicate balance between various interacting neuronal systems. To further understand gait control and specifically FOG, we will discuss the basic physiology of gait, animal models of gait disturbance including FOG, alternative etiologies of FOG, and functional magnetic resonance studies investigating FOG...
September 20, 2016: Annals of Neurology
Beata Lindholm, Maria H Nilsson, Oskar Hansson, Peter Hagell
The 3-step falls prediction model (3-step model) that include history of falls, history of freezing of gait and comfortable gait speed <1.1 m/s was suggested as a clinical fall prediction tool in Parkinson's disease (PD). We aimed to externally validate this model as well as to explore the value of additional predictors in 138 individuals with relatively mild PD. We found the discriminative ability of the 3-step model in identifying fallers to be comparable to previously studies [area under curve (AUC), 0...
September 19, 2016: Journal of Neurology
Merve Kasap, Kendra Bonnett, Eric J Aamodt, Donard S Dwyer
The Na(+) leak-current channel (NALCN) regulates locomotion, respiration and intellectual development. Previous work highlighted striking similarities between characteristic movement phenotypes of NALCN-deficient animals (Drosophila and C. elegans) and the major symptoms of Parkinson's disease and primary progressive freezing gait. We have discovered novel physiological connections between the NALCN, K(+) channels and gap junctions that mediate regulation of locomotion in C. elegans. Drugs that block K(+) channels and gap junctions or that activate Ca(++) channels significantly improve movement of NALCN-deficient animals...
September 16, 2016: Journal of Comparative Neurology
Emily Owens, Keith A Josephs, Rodolfo Savica, Anhar Hassan, Bryan Klassen, James Bower, Demetrius Maraganore, Joseph Matsumoto, J E Ahlskog
Gait freezing as a presenting and relatively restricted condition is uncommon but a distinctive disorder. This entity was initially defined as "pure akinesia with gait freezing", and later a neuropathological substrate of progressive supranuclear palsy has been recognized. Limited studies have reported the clinical evolution after presentation, which is important for patient counseling. The objective of this study was to assess the demographic and clinical features, treatment-response, neuroimaging, and evolution of pure akinesia with gait freezing...
September 13, 2016: Journal of Neurology
Sara G Lutz, Jeffrey D Holmes, Emily A Ready, Mary E Jenkins, Andrew M Johnson
Up to 40% of all individuals with Parkinson's disease (PD) are estimated to experience anxiety that interferes with daily functioning. This article describes research regarding the presentation of anxiety in PD and the influence anxiety has on participation in this population. A scoping review identified 1,635 articles, of which 49 met the inclusion criteria. This review identified that anxiety in PD is often associated with a range of clinical correlates related to demographic and clinical characteristics (age, gender, disease stage, duration, progression), motor symptoms (tremor, bradykinesia, dystonia, freezing of gait, symptom severity), treatment-related complications (on/off fluctuations, on with dyskinesia, unpredictable off), and non-motor symptoms (sleep abnormalities, fatigue, cognitive impairment, depression)...
July 2016: OTJR: Occupation, Participation and Health
Arnaud Delval, Mélanie Rambour, Céline Tard, Kathy Dujardin, David Devos, Séverine Bleuse, Luc Defebvre, Caroline Moreau
BACKGROUND: Parkinsonian patients have a tendency to speed up during repetitive motor tasks (festination) and to experience sudden motor blocks (freezing). In this article, we prospectively studied the appearance and progression of these phenomena in 30 early-stage PD patients. METHODS: A total of 30 controls and early-stage PD patients were assessed in the "off-drug" condition at baseline and 2 years later. Freezing of gait was evaluated using a standardized gait trajectory with the usual triggers...
September 13, 2016: Movement Disorders: Official Journal of the Movement Disorder Society
Fariborz Rahimi, Angela C Roberts, Mandar Jog
OBJECTIVES: Freezing of gait (FoG) is a challenging clinical symptom in Parkinson's disease with variable improvements in FoG with rasagiline. In this prospective, uncontrolled, pre-/post- treatment pilot study, we explore the clinical variables that contribute to this variability and those that predict improvement. PATIENTS AND METHODS: Frequency and duration of FoG, along with other standardized scales, were evaluated in 18 optimally medicated PD participants with intractable FoG, prior to and after completion of a 90-day course of 1mg daily rasagiline...
November 2016: Clinical Neurology and Neurosurgery
Halil Onder
Here, I discuss the report by Dale et al. and present some relevant comments, hoping that it will allow a better understanding of the patient's situation as well as freezing of gait phenomenon. I will also discuss other disorders for differential diagnosis those should be kept in mind.
2016: Journal of Clinical Movement Disorders
Mehmet Karakoc, Mehmet Ilker Yon, Gul Yalcin Cakmakli, Ersin Kasim Ulusoy, Aydin Gulunay, Nese Oztekin, Fikri Ak
We aimed to investigate the association between drooling and possible etiological factors in Parkinson's disease (PD) and to determine its effect on the quality of life. Demographic data of the 63 patients with idiopathic PD were recorded. Radboud Oral Motor Inventory for Parkinson's disease (ROMP) test was administered to all patients to evaluate speech, swallowing functions, and saliva control. The freezing of gait questionnaire (FOGQ) was used to evaluate gait and freezing of gait. Dynamic Parkinson gait scale (DYPAGS) was administered for the objective quantification of PD gait features...
September 9, 2016: Neurological Sciences
Alberto Cucca, Milton C Biagioni, Jori E Fleisher, Shashank Agarwal, Andre Son, Pawan Kumar, Miroslaw Brys, Alessandro Di Rocco
Freezing of gait (FOG) is 'an episodic inability to generate effective stepping in the absence of any known cause other than parkinsonism or high level gait disorders'. FOG is one of the most disabling symptoms in Parkinson's disease, especially in its more advanced stages. Early recognition is important as FOG is related to higher fall risk and poorer prognosis. Although specific treatments are still elusive, there have been recent advances in the development of new therapeutic approaches. The aim of this review is to present the latest knowledge regarding the phenomenology, pathogenesis, diagnostic assessment and conventional treatment of FOG in Parkinson's disease...
October 2016: Neurodegenerative Disease Management
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