Progress and Prospects in Parkinson's Research/Therapy/Symptomatic Relief/Akinesia
Background
[edit | edit source]Freezing or akinesia is a symptom experienced by many PD patients. It takes the form of a sudden inability to initiate movement, such as crossing the threshold into a room.The phenomenon is also referred to as Freezing Of Gait or FOG.
Research
[edit | edit source]2001
Giladi et al [1] carried out a detailed evaluation of freezing in a cohort of 800 PD patients. Among their observations:-
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.
2008
Honga and Earharta [2] experimented with the use of a rotating treadmill in treating two PD patients who froze when they attempted to turn round. Both patients evidenced more freezing when turning left than right. After 10–15 minutes of training leftward turning on a rotating circular treadmill 1) neither subject froze during leftward turns, 2) muscle activity normalized, and 3) turning times decreased for leftward turns.
We hypothesize that training on the rotating treadmill may help to reinforce normal motor patterns for turning, whether it be by helping to standardize step length and reduce the sequence effect, counteracting baseline asymmetries in gait, and/or making turning more automatic and facilitating the voluntary generation of turning patterns. This work is important because it demonstrates the feasibility of successfully using such a device in PD and lays the groundwork for future work with larger samples.
2012
Niu et al [3] measured the effects of deep brain stimulation of the subthalamic nucleus on freezing. Their conclusion:-
STN-DBS improved FOG in patients with advanced Parkinson's disease. The significant reduction in levodopa dosage and improvement in neuropsychological function may be the reason for the therapeutic effect seen with STN-DBS.
Today
Use the following links to query the PubMed, PubMed Central and Google Scholar databases using the Search terms:- Parkinson's freezing.
This will list the latest papers on this topic. You are invited to update this page to reflect such recent results, pointing out their significance.
Further Reading
[edit | edit source]2010
Morris, Meg E.; Martin, Clarissa L. and Schenkmann, Margaret L. Full Text Phys. Ther. 90 (2): 280–288.
Striding Out With Parkinson Disease: Evidence-Based Physical Therapy for Gait Disorders
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2816030/?tool=pmcentrez
References
[edit | edit source]<references>
- ↑ Giladi, N.; McDermott, M.P.; Fahn, S.; Przedborski, S.; Jankovic, J.; Stern, M. and Tanner, C. (2001) AbstractNeurology 56 (12) 1712 – 1721. Freezing of gait in PD -Prospective assessment in the DATATOP cohort http://www.neurology.org/content/56/12/1712.short
- ↑ Honga, Minna and Earharta, Gammon M. (2008) Full Text Parkinsonism Relat. Disord. 14 (4): 359–363. Rotating treadmill training reduces freezing in Parkinson disease: preliminary observations http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2446473/?tool=pmcentrez
- ↑ Niu, L.; Ji, L.Y.; Li, J.M.; Zhao, D.S.; Huang, G.; Liu, W.P.; Qu, Y.; Ma, L.T. and Ji, X.T. (2012) Abstract J. Int. Med. Res. 40 (3):1108-1113. Effect of bilateral deep brain stimulation of the subthalamic nucleus on freezing of gait in Parkinson's disease. http://www.ncbi.nlm.nih.gov/pubmed/22906284