Characterization of freezing of gait subtypes and the response of each to levodopa in Parkinson's disease

J. D. Schaafsma, Y. Balash, T. Gurevich, A. L. Bartels, J. M. Hausdorff, Nir Giladi*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

575 Scopus citations

Abstract

To assess the effect of levodopa on distinct freezing of gait (FOG) subtypes in patients with 'off' FOG. Nineteen patients (12 men, mean age 62.0 ± 8.4 years) with Parkinson's disease and clinically significant FOG during 'off' states were videotaped whilst walking 130 m during 'off' and 'on' states. Three independent observers characterized the type, duration, and clinical manifestations and quantified FOG by analyzing the videotapes. Their combined mean scores were used for statistical analysis. The intra-class correlation coefficient assessed inter-observer reliability. Wilcoxon and Friedman tests evaluated differences in mean frequencies of FOG characteristics. During 'off' states, FOG was elicited by turns (63%), starts (23%), walking through narrow spaces (12%) and reaching destinations (9%). These respective values were only 14, 4, 2 and 1% during 'on' states (P < 0.011). Moving forward with very small steps and leg trembling in place were the most common manifestations of FOG; total akinesia was rare. Most FOG episodes took < 10 s and tended to be shorter during 'on' states. Levodopa significantly decreased FOG frequency (P < 0.0001) and the number of episodes with akinesia (P < 0.001). Distinction amongst FOG subtypes enables evaluation of distinctive therapeutic response. Levodopa helps in reducing the frequency and duration of 'off'-related FOG.

Original languageEnglish
Pages (from-to)391-398
Number of pages8
JournalEuropean Journal of Neurology
Volume10
Issue number4
DOIs
StatePublished - Jul 2003

Funding

FundersFunder number
Eunice Kennedy Shriver National Institute of Child Health and Human DevelopmentR01HD039838

    Keywords

    • Freezing of gait
    • Parkinson's disease
    • Paroxysmal gait disturbances

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