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From the Movement Disorders Division (Drs. Giladi, Fahn, and Przedborski), Department of Neurology, Columbia–Presbyterian Medical Center, New York; the Department of Biostatistics (Dr. McDermott), University of Rochester School of Medicine, NY; the Department of Neurology (Dr. Jankovic), Baylor College of Medicine, Houston, TX; the Department of Neurology (Dr. Stern), University of Pennsylvania School of Medicine, Philadelphia, PA; and the Parkinson’s Institute (Dr. Tanner), Sunnyvale, CA.
Address correspondence and reprint requests to Dr. Stanley Fahn, Neurological Institute, 710 West 168th Street, New York, NY 10032; e-mail: fahn{at}movdis.cis.columbia.edu
OBJECTIVE: To study the development of freezing of gait in PD.
BACKGROUND: Freezing of gait is a common, disabling, and poorly understood symptom in PD.
METHODS: The authors analyzed data from 800 patients with early PD from the Deprenyl and Tocopherol Antioxidative Therapy of Parkinsonism (DATATOP) clinical trial who were assigned either placebo, deprenyl, tocopherol, or the combination of deprenyl and tocopherol. The primary outcome measure was the time from randomization until the freezing of gait score on the Unified Parkinson’s Disease Rating Scale (UPDRS) became positive.
RESULTS: Fifty-seven patients (7.1%) had freezing of gait at study entry and 193 (26%) of the remaining patients experienced the symptom by the end of the follow-up period. Those with freezing of gait at baseline had significantly more advanced disease than those without the symptom, as measured by total UPDRS and Hoehn and Yahr stage. High baseline risk factors for developing freezing of gait during the follow-up period were the onset of PD with a gait disorder; higher scores of rigidity, postural instability, bradykinesia and speech; and longer disease duration. In contrast, tremor was strongly associated with a decreased risk for freezing of gait. At the end of follow-up, the signs most strongly associated with the freezing phenomenon were gait, balance, and speech disorders, not rigidity or bradykinesia. Deprenyl treatment was strongly associated with a decreased risk for developing freezing of gait; tocopherol had no effect.
CONCLUSIONS: Freezing of gait is directly related to duration of PD. Risk factors at onset of disease are the absence of tremor and PD beginning as a gait disorder. The development of freezing of gait in the course of the illness is strongly associated with the development of balance and speech problems, less so with the worsening of bradykinesia, and is not associated with the progression of rigidity. These results support the concept that the freezing phenomenon is distinct from bradykinesia. Deprenyl, in the absence of L-dopa, was found to be an effective prophylactic treatment and should be considered for patients with PD who have an onset of gait difficulty.
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