Clinical patterns of gait freezing in Parkinson's disease and their response to interventions: An observer-blinded study. (November 2020)

• Record Type: Journal Article
• Authors: Gavriliuc, Olga; Paschen, Steffen; Andrusca, Alexandru; Helmers, Ann-Kristin; Schlenstedt, Christian; Deuschl, Günther
• Is Part Of: Parkinsonism & related disorders. Volume 80(2020)
• Page Start: 175
• Page End: 180
• Publication Date: 2020-11
• Subjects: Parkinson disease -- Gait -- Freezing -- Deep brain stimulation -- Levodopa; Parkinson's disease -- Periodicals; Movement disorders -- Periodicals; Movement Disorders -- Periodicals; Nerve Degeneration -- Periodicals; Nervous System Diseases -- Periodicals; Parkinson Disease -- Periodicals; Tremor -- Periodicals; Parkinson, Maladie de -- Périodiques; Parkinson's disease; 616.833
• DOI: 10.1016/j.parkreldis.2020.09.043
• Languages: English
• ISSNs: 1353-8020

Abstract

Abstract: Background: Freezing of gait (FOG) in Parkinson's disease (PD) is provoked by specific situations. The sensitivity of these situations to detect FOG and the relative FOG response to l -dopa and subthalamic nucleus deep brain stimulation (STN-DBS) is unknown. Methods: Two blinded reviewers analyzed the video recordings of a standardized patient assessment before and 10 months after DBS-implantation of 124 PD patients with positive FOG according to the Unified Parkinson Rating Scale part II item 14. Baseline evaluations were done under 2 conditions (OFF- and ON-drug states). Postoperatively, the patients were evaluated under 4 conditions (OFF-drug/OFF-stim, OFF-drug/ON-stim, ON-drug/OFF-stim, and ON-drug/ON-stim). FOG frequency and its severity was rated during different provoking situations (start, turning, reaching a destination and open space hesitations) during a standardized walking task. Cumulative link mixed models were calculated to investigate the immediate and carry-over effect of medication and stimulation. Results: Eighty-one percent of patients presented FOG at least in one provoking situation on video assessment. During turning, the FOG severity was significantly worse than for the other subtypes (p < 0.0001). Both interventions improve all FOG subtypes similarly. The effect size of l -dopa and STN-DBS on subtypes were similar (p > 0.05), but the combined intervention had a stronger effect on FOG severity (p < 0.0001) compared to each intervention separately. FOG severity was lower at follow-up OFF compared to baseline OFF condition (p < 0.02) demonstrating a carry-over effect of STN-DBS. Conclusion: Turning is the most sensitive provoking situation for gait freezing. STN-DBS and l -dopa improve all FOG subtypes similarly, their effect is stronger in combination. Highlights: l -dopa and STN-DBS on freezing of gait was tested in 124 patients with Parkinson's disease before and 1 year after STN-DBS. A rating score based on provoking situations discovered freezing off-intervention in >80% of the participants. Turning was the most provoking situation. The effect of l -Dopa and STN-DBS is similar but the combined effect is stronger. STN-DBS has a carry over effect lasting at least 1 h.