title: Treatment of gait ignition failure with ropinirole.
abstract: Gait ignition failure (GIF) is a syndrome characterized by hesitation or inability to initiate gait from a static position. It may occur in a variety of conditions, including normal pressure hydrocephalus, subcortical vascular disease, parkinsonian syndromes and a variety of focal lesions. Previous information on the treatment of GIF has been primarily anecdotal, but there have been a few reports of response to dopamine agonists. We report a 63-year-old man with anoxic encephalopathy who developed GIF nine years after the initial anoxic insult. The patient's GIF responded robustly, albeit transiently, to ropinirole. MRI was unrevealing, but a positron emission tomography scan showed hypometabolism in the deep frontal ACA/MCA watershed area; this may have disconnected the basal ganglia from the motor cortex and/or interrupted dopaminergic mesocortical transmission. Our understanding of the pathophysiology and the treatment of GIF remains limited, but there may be at least a limited therapeutic role for dopamine agonists.
authors.affiliation: Department of Psychiatry, University of South Florida College of Medicine, Tampa, FL, USA.
authors.forename: Alexis N
authors.initials: AN
authors.lastname: Cohen-Oram
authors.affiliation: Mental Health and Behavioral Science Service, James A Haley VA Hospital, Tampa, FL, USA; Departments of Psychiatry and Geriatric Medicine, University of South Florida College of Medicine, Tampa, FL, USA.
authors.forename: Jonathan T
authors.initials: JT
authors.lastname: Stewart
authors.affiliation: Kinesiotherapy Service, James A Haley VA Hospital, Tampa, FL, USA.
authors.forename: Kim
authors.initials: K
authors.lastname: Bero
authors.affiliation: Stroke and Cognitive Programs, James A Haley VA Hospital, Tampa, FL, USA; Department of Neurology, University of Central Florida College of Medicine, Orlando, FL, USA.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Hoffmann
keywords: Anoxic encephalopathy; Dopamine agonists; Gait; Gait ignition failure; Ropinirole