title: Freezing of gait: a practical approach to management.
abstract: Freezing of gait is a common and disabling symptom in patients with parkinsonism, characterised by sudden and brief episodes of inability to produce effective forward stepping. These episodes typically occur during gait initiation or turning. Treatment is important because freezing of gait is a major risk factor for falls in parkinsonism, and a source of disability to patients. Various treatment approaches exist, including pharmacological and surgical options, as well as physiotherapy and occupational therapy, but evidence is inconclusive for many approaches, and clear treatment protocols are not available. To address this gap, we review medical and non-medical treatment strategies for freezing of gait and present a practical algorithm for the management of this disorder, based on a combination of evidence, when available, and clinical experience of the authors. Further research is needed to formally establish the merits of our proposed treatment protocol.
authors.affiliation: Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands.
authors.forename: Jorik
authors.initials: J
authors.lastname: Nonnekes
authors.affiliation: Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands.
authors.forename: Anke H
authors.initials: AH
authors.lastname: Snijders
authors.affiliation: Department of Neurology, Oregon Health and Science University, Portland, OR, USA.
authors.forename: John G
authors.initials: JG
authors.lastname: Nutt
authors.affiliation: Department of Neurology, Christian-Albrechts University, Kiel, Germany.
authors.forename: Günter
authors.initials: G
authors.lastname: Deuschl
authors.affiliation: Sagol School for Neuroscience, Movement Disorders Unit, Department of Neurology, Tel-Aviv Medical Centre, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Nir
authors.initials: N
authors.lastname: Giladi
authors.affiliation: Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands. Electronic address: bas.bloem@radboudumc.nl.
authors.forename: Bastiaan R
authors.initials: BR
authors.lastname: Bloem
mesh_terms: D046690:Deep Brain Stimulation / Q000379:methods; D019468:Disease Management; D015259:Dopamine Agents / Q000627:therapeutic use; D020233:Gait Disorders, Neurologic / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D026741:Physical Therapy Modalities
chemical_list: D015259:Dopamine Agents