Freezing of gait
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Freezing je náhlý záraz na začátku nebo během chůze, který se objevuje v určitých typických situacích. Kromě Parkinsonovy nemoci se vyskytuje u dalších parkinsonských syndromů neurodegenerativní či vaskulární etiologie, u normotenzního hydrocefalu a při poškození frontálního kortexu a jeho spojů. Článek se zabývá rozdělením freezingu, diagnózami, u kterých se vyskytuje, patofyziologií, diagnostikou a léčbou tohoto fenoménu.
Freezing is a sudden interruption of gait in the beginning or during walking, which occurs in typical situations. In addition to Parkinson's disease appears in neurodegerative and vascular parskinsonian syndromes, normal pressures hydrocephalus and in frontal and frontal circuit's lesion. This is a summary about classification, diagnosis including freezing, patophysiology and therapy of this fenomen.
AIMS: The relationship between freezing of gait (FOG) and regional brain atrophy has been intensively investigated, but it is still not clearly understood. The study objective was to test whether grey matter (GM) atrophy contributes to FOG in Parkinson's disease (PD) using a surface-based algorithm. METHODS: We investigated 21 patients with PD, 11 with FOG and 10 without FOG. Both groups were assessed using a FOG questionnaire and Hoehn and Yahr staging. High resolution T1-weighted brain images were acquired for each subject using a 1.5T MRI scanner. A surface-based method implemented in FreeSurfer was used to quantify the GM atrophy. A vertex-wise and region of interest (ROI) comparison of spatially normalized subject data using a general linear model and the Wilcoxon rank sum test were to assess significant group differences. RESULTS: Higher global levels of cortical atrophy were detected in freezers, although this was not statistically significant. The vertex-wise analysis revealed significant local reduction in grey matter thickness in the left supplementary motor area, middle/anterior cingulate cortex, temporal pole and right frontal operculum in freezers at P<0.001, uncorrected. The ROI analysis of average thickness confirmed the regional atrophy in bilateral anterior and posterior cingulate cortices. No significant relative regional cortical atrophy was observed in non-freezers. CONCLUSION: FOG was associated with regional cortical atrophy, especially in mesial frontal and cingulate cortices. Our findings provide additional evidence that the development of FOG in patients with PD is associated with local structural cortical changes.
- MeSH
- atrofie diagnostické zobrazování MeSH
- čelní lalok diagnostické zobrazování patologie MeSH
- difuzní magnetická rezonance MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- neurologické poruchy chůze diagnostické zobrazování etiologie patologie MeSH
- Parkinsonova nemoc diagnostické zobrazování etiologie patologie patofyziologie MeSH
- šedá hmota diagnostické zobrazování patologie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Tento článok opisuje relatívne „mladú“ a zriedkavú diagnózu z okruhu extrapyramidových porúch hybnosti, známu ako syndróm čistej akinézy alebo čistá akinéza s freezingom chôdze. Jej základným klinickým prejavom je akinéza a progredujúce zamŕzanie hybnosti počas chôdze, v reči a pri písaní, neodpovedajúce na liečbu levodopou. Rigidita končatín, porucha okulomotoriky a demencia sa nevyskytujú. Patologické nálezy pri tomto ochorení zobrazujú typické prejavy progresívnej supranukleárnej obrny, preto sa syndróm čistej akinézy považuje za klinický variant tohto ochorenia. V článku je predložená krátka kazuistika pacienta, ktorá zachytáva postupný prechod sedem rokov trvajúcej čistej akinézy do typických klinických a zobrazovacích známok progresívnej supranukleárnej obrny.
This article describes a relative „young“ and rare diagnosis on the field of movement disorders, known as pure akinesia or pure kinesia with gait freezing. The cardinal clinical feauture of the syndrome is akinesia and levodopa-resistant progressive freezing during walking, speaking and handwriting. Limb rigidity, oculoparesis and dementia are not present. Pathologically this syndrome shows changes typical for progressive supranuclear palsy, therefore pure akinesia is regarded as its clinical variant. The article presents a short clinical case of a patient reflecting a graduate conversion of seven years existing pure akinesia to the typical clinically and imaging signs of progressive supranuclear palsy.
- Klíčová slova
- syndrom čisté akineze, čistá akineze s freezingem chůze (PAGF), poruchy rukopisu,
- MeSH
- audiovizuální záznam * metody využití MeSH
- diagnostické techniky neurologické * využití MeSH
- levodopa aplikace a dávkování škodlivé účinky terapeutické užití MeSH
- lidé MeSH
- magnetická rezonanční tomografie metody využití MeSH
- neurologické poruchy chůze diagnóza etiologie terapie MeSH
- pohybové poruchy diagnóza etiologie terapie MeSH
- progresivní supranukleární obrna * diagnóza etiologie terapie MeSH
- senioři nad 80 let MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- Publikační typ
- kazuistiky MeSH
AIMS: Freezing of gait is a disabling symptom in advanced Parkinson's disease. Positive effects have been suggested with MAO-B inhibitors. We report on an open label clinical study on the efficacy of rasagiline as add-on therapy on freezing of gait and quality of life in patients with Parkinson's disease. METHODS: Forty two patients with freezing of gait were treated with 1 mg rasagiline daily as an add-on therapy. Patients were assessed at baseline and after 1, 2 and 3 months of treatment. Freezing of gait severity was assessed using the Freezing of Gait Questionnaire, motor impairment by the modified MDS UPDRS part III, and quality of life using the PDQ-39 questionnaire. RESULTS: Patients treated with rasagiline had a statistically significant decrease in FoG-Q score and modified MDS UPDRS score after 1, 2 and 3 months of therapy. A moderately strong (r = 0.686, P = 0.002) correlation between the effects on mobility and freezing of gait was found. We also observed a statistically significant improvement in global QoL and in the subscales mobility, ADL, stigma and bodily discomfort in patients after 3 months of rasagiline therapy. A significant correlation (r = 0.570, P = 0.02) between baseline FoG-Q score and the baseline score for the PDQ Mobility subscale was found. CONCLUSION: In our study rasagiline as add-on antiparkinsonian therapy significantly improved mobility, freezing of gait and quality of life. The positive effect on freezing of gait appears to be related to improvement of mobility.
- MeSH
- analýza rozptylu MeSH
- antiparkinsonika aplikace a dávkování MeSH
- indany aplikace a dávkování MeSH
- kvalita života MeSH
- lidé MeSH
- neurologické poruchy chůze farmakoterapie MeSH
- Parkinsonova nemoc farmakoterapie MeSH
- průzkumy a dotazníky MeSH
- rozvrh dávkování léků MeSH
- senioři MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- klinické zkoušky MeSH
- multicentrická studie MeSH
- MeSH
- chůze (způsob) MeSH
- lidé MeSH
- Parkinsonova nemoc diagnóza terapie MeSH
- pohybové poruchy diagnóza MeSH
- Check Tag
- lidé MeSH
BACKGROUND: The Freezing of Gait Questionnaire (FoG-Q) is a fast and sensitive assessment tool for freezing (FoG). OBJECTIVE: The objective of the study is for validation of a Czech version of FoG-Q. A further, explorative aim was to examine what FoG-Q indicates about the presence and severity of gait impairment in patients treated with DBS in their full OFF state. DESIGN: The study was a cross-sectional validation study. METHODS: We translated FoG-Q following standardized validation protocol. We assessed 35 patients with PD and STN DBS using history taking, UPDRS, Hoehn and Yahr staging, Mini Mental State Examination, Frontal Assessment Battery, FoG-Q, Short Falls Efficacy Scale International, and Beck Depression Inventory, Second Edition. UPDRS III, clinical and instrumental gait assessment, was repeated OFF MED/DBS OFF and OFF MED/DBS ON. RESULTS: Internal consistency of FoG-Q was excellent (α = 0.91) as well as convergent (significant correlations with UPDRS II item 14, UPDRS III item 29, several TUG parameters, and FoG Score) and divergent validity (no association with UPDRS I). OFF MED/DBS OFF, the total FoG-Q score correlated with UPDRS III items 29, 30, and PIGD subscore, step time variability, and negatively with step length and velocity. LIMITATIONS: Limitation of the study is a relatively small sample size. CONCLUSIONS: In conclusion, the Czech translation of FoG-Q is valid. With respect to gait and balance, FoG-Q does, to a certain extent, reflect the native state of the disease in patients treated with high frequency STN DBS.
- MeSH
- hluboká mozková stimulace * MeSH
- lidé středního věku MeSH
- lidé MeSH
- neurologické poruchy chůze diagnóza MeSH
- Parkinsonova nemoc diagnóza terapie MeSH
- průřezové studie MeSH
- průzkumy a dotazníky * MeSH
- psychiatrické posuzovací škály MeSH
- reprodukovatelnost výsledků MeSH
- senioři MeSH
- stupeň závažnosti nemoci MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
- validační studie MeSH
BACKGROUND: Freezing of gait (FOG) is a common disabling symptom of (in) Parkinson's disease (PD). The mechanism of FOG is (in) not clearly understood. We investigated the clinical effect and changes of the activity of the sensorimotor system using repeated functional MRI (fMRI) before and after application of botulinum toxin in Parkinson's disease patients with FOG. METHODS: We investigated 20 patients with PD, 10 with FOG and 10 without FOG. PD patients with FOG were treated with intramuscular application of botulinum toxin type A into the tensor fasciae latae muscle bilaterally. The clinical effect of treatment was assessed using FOG questionnaire, "Time up and go" test, UPDRS, Hoehn and Yahr staging, Clinical global impression scale. Activation of the sensorimotor system was studied using BOLD fMRI of the whole brain during repetitive abduction - adduction of each leg interleaved with rest. The clinical (in the FOG group) and imaging (in both groups) examination was repeated after a four-week interval. RESULTS: In the FOG group, the FOG questionnaire has shown a decline of scores after application of botulinum toxin that suggests possible effect of botulinum toxin on freezing of gait. In fMRI results, both groups manifested reduction of the sensorimotor network activated with leg movement, however, the FOG group also showed increased activation in cerebellar vermis and nuclei, in dorsal pons and in medulla after treatment. CONCLUSION: Alleviation of the FOG in PD patients by botulinum toxin seems to be reflected in the functional participation of the cerebellum and its projections as seen by fMRI.
Functional gait disorders are common in clinical practice. They are also usually disabling for affected individuals. The diagnosis is challenging because no single walking pattern is pathognomonic for a functional gait disorder. Establishing a diagnosis is based not primarily on excluding organic gait disorders but instead predominantly on recognizing positive clinical features of functional gait disorders, such as an antalgic, a buckling, or a waddling gait. However, these features can resemble and overlap with organic gait disorders. It is therefore necessary to also look for inconsistency (variations in clinical presentation that cannot be reconciled with an organic lesion) and incongruity (combination of symptoms and signs that is not seen with organic lesions). Yet, these features also have potential pitfalls as inconsistency can occur in patients with dystonic gait or those with freezing of gait. Similarly, patients with dystonia or chorea can present with bizarre gait patterns that may falsely be interpreted as incongruity. A further complicating factor is that functional and organic gait disorders may coexist within the same patient. To improve the diagnostic process, we present a sign-based approach-supported by videos-that incorporates the diverse clinical spectrum of functional gait disorders. We identify 7 groups of supportive gait signs that can signal the presence of functional gait disorders. For each group of signs, we highlight how specific clinical tests can bring out the inconsistencies and incongruencies that further point to a functional gait disorder.
BACKGROUND: Public spaces are usually designed with respect to various patient populations, but not Parkinson's disease. The objective of this study was to explore what type of easily applicable visual cueing might be used in public spaces and some interiors to improve gait in people with Parkinson's disease. METHODS: Thirty-two patients with freezing of gait walked an 8-meter track on 6 different floor patterns in single- and dual-task conditions in random sequence. The reference pattern was a virtual large transverse chessboard, and the other patterns differed either in size (small floor stones), orientation (diagonal), nature (real paving), regularity (irregular), or no pattern. Time, number of steps, velocity, step length, cadence, and dual-task effect were calculated. The number and total duration of freezing episodes were analyzed. RESULTS: Virtual, large, transverse floor stones improve time (P = 0.0101), velocity (P = 0.0029), number of steps (P = 0.0291), and step length (P = 0.0254) in Parkinson's disease patients compared with walking on no pattern. Virtual floor stones were superior in time and velocity to the real ones. Transverse floor stones were better than diagonal, whereas regular pattern stones were superior to irregular in some gait parameters. Subjectively, the reference pattern was preferred to the irregular one and to no pattern. No direct effect on freezing of gait was observed. CONCLUSIONS: Parkinson's disease patients may benefit from floor patterns incorporating transverse oriented large rectangular visual cues. Because public space can be regulated with respect to people with medical conditions, the relevant legislative documents should be extended to allow for parkinsonian gait disorder. © 2019 International Parkinson and Movement Disorder Society.
- MeSH
- chůze (způsob) MeSH
- chůze MeSH
- lidé středního věku MeSH
- lidé MeSH
- neurologické poruchy chůze etiologie rehabilitace MeSH
- orientace MeSH
- Parkinsonova nemoc komplikace rehabilitace MeSH
- podněty * MeSH
- psychomotorický výkon MeSH
- senioři MeSH
- světelná stimulace * MeSH
- virtuální realita MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
