Diagnosis and treatment of parkinsonism with freezing of gait: A prospective study / 第二军医大学学报

ABSTRACT

[Abstract] Objective To study the clinical diagnosis and treatment of parkinsonism (PDS) with freezing of gait (FoG), so as to provide clues to delay the progress of the symptom. Methods A prospective study was designed. The outpatients of PDS with the main complaint of FoG were included and followed up for 2-6 years in the Department of Neurology, Changzheng Hospital, Naval Medical University (Second Military Medical University) from Nov. 2010 to Jan. 2016. The patients were given L-dopa first, and then antidepressants and other therapies (including other medication and surgery) were given if the previous treatments were not effective. The motor function of patients was evaluated by Hoehn-Yahr staging scale and the second and third part of the unified Parkinson disease rating scale (UPDRS); the general mental, behavior and emotional state were evaluated by the first part of UPDRS; the cognition was evaluated by minimum mental state examination (MMSE); depression and anxiety were evaluated by 17-item Hamilton depression scale (HAMD-17) and Hamilton anxiety scale (HAMA); and the severity of FoG was evaluated by the timed up and go test (TUGT). Results Six of the 15 cases with FoG were diagnosed as Parkinson disease (PD), and 9 had other disorders (2 with progressive supranuclear palsy, 3 with primary progressive FoG, 1 with frontotemporal dementia, 1 with vascular PDS, 1 with drug-induced PDS, and 1 with unknown-cause PDS). There were no significant differences in age, gender, severity of symptom or mental state (Hoehn-Yahr stage, UPDRS- score, UPDRS-Ⅱ score, UPDRS-III score, MMSE score, HAMD-17 score, HAMA score and TUGT time) between PD group and non-PD group (all P0.05). At the baseline, the FoG duration of PD patients ([7.50±2.66] years) was longer than that of non-PD patients ([2.56±0.88] years, P0.01). After treatment with increasing dose of L-dopa, 4 PD patients were improved while non-PD patients had no responses (4/6 vs 0/9, P＝0.01). Conclusion The causes of PDS with FoG are heterogeneous. The duration of FoG is helpful for diagnosis of idiopathic PD, while the severity of FoG has little value for etiological analysis. Increasing the dose of L-dopa is effective for FoG in advanced PD, while it has uncertain effect for FoG of other reasons.