Biphasic Levodopa-Induced Freezing of Gait in Parkinson's Disease

Jorik Nonnekes, Bastiaan R Bloem, Jorik Nonnekes, Bastiaan R Bloem

Abstract

The relation between freezing of gait in Parkinson's disease and levodopa is complex. Here, we describe a new phenotype of freezing of gait, namely levodopa-induced freezing of gait with a biphasic pattern. Our observation supports the idea that freezing of gait might emerge because of a mismatch between cognitive/limbic loops and motor loops involved in gait control. Moreover, it underscores the importance of assessing the influence of dopaminergic medication in daily clinical practice, including objective assessment in all three dopaminergic states. The possibility of biphasic freezing will only emerge after such a comprehensive evaluation, and will have immediate therapeutic consequences.

Keywords: Gait; Parkinson’s disease; biphasic; freezing of gait; levodopa; parkinsonism.

Conflict of interest statement

The authors report no conflict of interest.

References

    1. Weiss D, Schoellmann A, Fox MD, Bohnen NI, Factor SA, Nieuwboer A, Hallett M, Lewis SJG (2020) Freezing of gait: Understanding the complexity of an enigmatic phenomenon. Brain 143, 14–30.
    1. Nutt JG, Bloem BR, Giladi N, Hallett M, Horak FB, Nieuwboer A (2011) Freezing of gait: Moving forward on a mysterious clinical phenomenon. Lancet Neurol 10, 734–744.
    1. Nonnekes J, Timmer MH, de Vries NM, Rascol O, Helmich RC, Bloem BR (2016) Unmasking levodopa resistance in Parkinson’s disease. Mov Disord 31, 1602–1609.
    1. Espay AJ, Fasano A, van Nuenen BF, Payne MM, Snijders AH, Bloem BR (2012) “On” state freezing of gait in Parkinson disease: A paradoxical levodopa-induced complication. Neurology 78, 454–457.
    1. Calabresi P, Di Filippo M, Ghiglieri V, Tambasco N, Picconi B (2010) Levodopa-induced dyskinesias in patients with Parkinson’s disease: Filling the bench-to-bedside gap. Lancet Neurol 9, 1106–1117.
    1. Nonnekes J, Bereau M, Bloem BR (2019) Freezing of gait and its levodopa paradox. JAMA Neurol.doi: 10.1001/jamaneurol.2019.4006.
    1. Lewis SJ, Barker RA (2009) A pathophysiological model of freezing of gait in Parkinson’s disease. Parkinsonism Relat Disord 15, 333–338.
    1. Nonnekes J, Snijders AH, Nutt JG, Deuschl G, Giladi N, Bloem BR (2015) Freezing of gait: A practical approach to management. Lancet Neurol 14, 768–778.

Source: PubMed

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