Parkinson’s disease freezes gait

  Freezing gait is the most common and disabling pathological gait in the clinical manifestations of Parkinson’s disease, mostly occurring in the middle and late stages of the disease, and is prone to falls, trauma, and depression, seriously affecting the quality of life and social functioning of patients.  The manifestation of freezing gait in Parkinson’s disease: Freezing gait is defined as – “a brief, sudden suspension or significant reduction in pace when attempting to walk or during advancement”, mainly manifested as a transient block in movement, often with an asymmetrical gait and occasional onset of unilateral lower extremity. Patients start hesitantly, cannot walk or feel like their feet are “stuck” to the floor or sucked by the floor when walking, and have difficulty lifting and stepping, usually lasting for a few seconds, occasionally up to 30 seconds, and in the most severe cases, patients can walk at any time, requiring assistance from others or crutches, and may be accompanied by a certain degree of leg tremors. As the disease progresses, freezing gait becomes more frequent and causes falls.  Treatment of freezing gait in Parkinson’s disease: 95% of patients have freezing gait in the “off” phase, and the duration of freezing in the “off” phase is significantly longer than in the “on” phase. The most severe motor inability among the frozen gait subtypes is only seen in the “off” phase, and these phenomena suggest that levodopa can alleviate the frozen gait in the off phase. Therefore, when the freezing gait occurs only or mainly in the “off” phase, maintaining the patient in the “on” phase by adjusting the levodopa dose and changing the levodopa dosage form is the most conventional treatment method. The risk of freezing gait in Parkinson’s disease can be reduced by increasing the amount of dopamine agonists, adding catechol-oxygenation-methyltransferase inhibitors, monoamine oxidase inhibitors, and amantadine. However, amantadine was not effective in freezing gait that had already developed. Freezing gait only occurs in the “on” state is very rare and is more difficult to treat than in the “off” state, and levodopa is thought to be ineffective or aggravate freezing gait in the “on” state, when Reducing dopamine stimulation may reduce symptoms, but may also worsen other Parkinson’s symptoms such as tremor. Other drugs such as L-threo-DOPS (a precursor to norepinephrine), the 5-hydroxytryptamine agonist tandospirone, selective 5-hydroxytryptamine reuptake inhibitors, and the serotonin norepinephrine reuptake inhibitor methylphenidate have been reported to be useful in some patients with frozen gait, but these specific treatments require extensive clinical or research practice.  Deep brain electrical stimulation (DBS): Medial pallidum bulb (GPi) stimulation is effective for anisometropia and symptomatic fluctuations, and also for levodopa-responsive frozen gait. However, the effect is not long-lasting; both unilateral and bilateral thalamic floor nucleus (STN) stimulation can relieve frozen gait, more effectively bilaterally. Thalamic fundic nucleus-deep EEG stimulation significantly improved freezing in the off phase, but not in the on phase. The pedunculopontine nucleus (PPN) is currently considered as one of the possible alternative targets to the thalamic nucleus, but the clinical effects and mechanism of action of direct stimulation of the pedunculopontine nucleus are still controversial, so the effect of the pedunculopontine nucleus on frozen gait needs to be further investigated. Since stimulation of the pedunculopontine nucleus or pallidum alone has a certain effect on patients’ frozen gait, and co-stimulation significantly improves patients’ gait, combined stimulation of multiple target areas can be used clinically to improve frozen gait.  Rehabilitation training: Attentional decision making and cueing are used appropriately to improve gait and limb coordination, reduce limitations in postural balance, and thus improve patients’ frozen gait symptoms. Sensory cueing training provides rhythmic auditory, visual, tactile, or mental stimulation through external or portable sensors to compensate for proprioceptive deficits, adjusting gait variability and reducing frozen gait in Parkinson’s disease patients. And through various exercises such as dance, boxing and apparatus, it can help adjust patients’ gait speed and stride length, enhance motor automaticity, coordination and balance, so that patients’ gait can also be effectively improved and the number of freezing gait episodes can be reduced. In addition, assistive devices such as crutches, walkers and wheelchairs also play a role in the daily life of patients with frozen gait.