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From the Movement Disorder Group (Drs. Giladi, Przedborski, Kostic, and Fahn, and S. Guilloryl, Neurological Institute, and the Irving Center for Clinical Research (D. McMahon and E. Flaster), College of Physicians and Surgeons, Columbia University, New York, NY.
Freezing episodes and related phenomena (as a general term, motor blocks [MBs]) are poorly understood, particularly disabling, and a therapeutically frustrating problem in Parkinson's disease (PD). Epidemiologic and clinical characteristics of MBs, as well as risk factors to develop MBs, have never been fully addressed. Herein, we report our database survey on 990 PD patients, of whom 318 (32%) had MBs. The majority of MBs were linked to gait. Start hesitation occurred in 86%, blocking on turning in 45%, and blocking in narrow spaces in 25% of patients. Initial parkinsonian symptoms in the upper body and tremor as the initial motor symptom were less likely to be associated with the presence of MBs (odds ratios |OR| 0.6 and 0.7, respectively), while initial symptoms affecting gait or trunk had higher association with MBs (OR = 1.58). Longer disease duration, higher Hoehn and Yahr stage, and longer duration of levodopa treatment are all significantly associated with the presence of MBs. We observed significant association between the existence of MBs and levodopa-induced dyskinesias to suggest similar pathophysiology. We propose that MBs in PD are abnormal retrieval or execution of complex motor tasks that can occur as a result of disease progression or as short- or long-term side effects of levodopa treatment.
Address correspondence and reprint requests to Dr. Stanley Fahn, Room #201, Neurological Institute. College of Physicians and Surgeons, Columbia University, 710 West 168th Street, New York, NY 10032.
N.G. is an Engl Fellow of the Parkinson's Disease Foundation from the Department of Neurology, Carmel Hospital, Haifa, Israel. The Irving Center for Clinical Research is supported by NIH grant no. M01-RR-00645.
Received May 17, 1991. Accepted for publication in final form July 17, 1991.
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