title: Characterization of freezing of gait subtypes and the response of each to levodopa in Parkinson's disease.
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.
authors.affiliation: Movement Disorders Unit, Department of Neurology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: J D
authors.initials: JD
authors.lastname: Schaafsma
authors.forename: Y
authors.initials: Y
authors.lastname: Balash
authors.forename: T
authors.initials: T
authors.lastname: Gurevich
authors.forename: A L
authors.initials: AL
authors.lastname: Bartels
authors.forename: J M
authors.initials: JM
authors.lastname: Hausdorff
authors.forename: N
authors.initials: N
authors.lastname: Giladi
mesh_terms: D000368:Aged; D000978:Antiparkinson Agents / Q000627:therapeutic use*; D005260:Female; D020233:Gait Disorders, Neurologic / Q000145:classification / Q000188:drug therapy* / Q000209:etiology*; D006801:Humans; D007866:Leg / Q000503:physiopathology; D007980:Levodopa / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009038:Motion; D020734:Parkinsonian Disorders / Q000150:complications*; D015995:Prevalence; D011597:Psychomotor Performance; D012044:Regression Analysis; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D013997:Time Factors; D014743:Videotape Recording / Q000379:methods
chemical_list: D000978:Antiparkinson Agents; D007980:Levodopa