Gait festination in Parkinson's disease
Gait festination in Parkinson's disease
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DOI：
10.1016/s1353-8020(00)00030-4
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发表时间：
2001-04-01
影响因子：
4.1
通讯作者：
Shabtai, E
中科院分区：
文献类型：
--
作者：
Giladi, N;Shabtai, H;Shabtai, E
背景：成熟步态(FSG)首次与帕金森症联系在一起是由詹姆斯·帕金森爵士在他的原创文章《颤抖的瘫痪》中提出的。目的：研究帕金森病(PD)患者步态溃烂与其他帕金森病临床特征的关系。方法：在特拉维夫Sourasky医学中心运动障碍科(MDU)对帕金森病患者进行的一次公开讲座中，我们中的一人在舞台上口头讲解并模仿溃烂步态。所有在照顾者或家人的帮助下接受治疗的患者都被要求回答两个书面问题，内容是关于他们自己使用FSG的经历以及它导致的残疾程度。每个患者的临床信息是从他/她在MDU的病历中获取的，缺失的数据是在下一次办公室访问或从家庭医生那里获得的。组间比较采用t检验，趋势分析采用Chochran-Armitage检验，Logistic回归分析发病年龄、病程和病情严重程度对FSG的影响。结果：81例PD患者(男性58例，平均年龄67.5±10.7岁)完成了FSG问卷调查。本研究人群的平均病程为8.5+/-6.4年，平均Hoehn和Yahr(H&Y)临床分期为2.6+/-0.8，平均左旋多巴剂量为608+/-375 mg/d(15例患者未服用左旋多巴)。26名患者(32.1%)在上个月经历了FSG，其中56%的患者报告FSG是一种显著的致残症状。空腹血糖与高H&Y分期密切相关(p<；0.001)，且随着疾病的进展有显著的趋势(p=0.001)，但与统一帕金森病评定量表的运动部分总分无关。在多变量模型中，较长的病程是唯一的临床因素，被发现与空腹血糖相关。37%(37%)的FSG患者报告了频繁跌倒与偶尔或频繁跌倒之间的关系，这与UPDRS中日常生活能力(ADL)部分的报告一样，与FSG的存在有关(p<；0.08)。在UPDRS客观部分评定的显著姿势反射异常与FSG的存在之间没有关联。在UPDRS的日常生活活动部分中报告的步态冻结(FOG)的存在与FSG的存在之间存在显著的相关性(p<；0.001)，并且在雾更严重的患者中有更频繁的FSG的显著趋势(p<；0.001)。结论：FSG明显与PD症状的持续时间较长有关，但与UPDRS的运动部所反映的疾病严重程度无关。FSG和姿势反射异常之间的关系尚不清楚，但它经常与跌倒和步态冻结有关。(C)2001爱思唯尔科学有限公司。保留所有权利。
Background: Festinating gait (FSG) was first associated with parkinsonism by Sir James Parkinson, in his original essay on "The Shaking Palsy". Its frequency and relation to other parkinsonian features have never been assessed.Objective: To study the relationships between gait festination and other parkinsonian clinical features among patients with Parkinson's disease (PD).Method: During an open lecture to patients with PD who are followed at the Movement Disorders Unit (MDU) of Tel-Aviv Sourasky Medical Center one of us explained verbally and imitated festinating gait on stage. All attending patients with the help of their care-givers or family members, were asked to answer two written questions regarding their own experience with FSG as well as the degree of disability it causes. Clinical information about each patient was taken from his/her chart at the MDU and missing data was completed during the next office visit or from the family physician. Statistical analysis was performed using t-tests for comparison between groups, Chochran-Armitage test for trends and logistic regression to assess the contribution of age of onset, disease duration and disease severity to the development of FSG.Results: Eighty-one PD patients (58 males, mean age 67.5 +/- 10.7 years) answered the FSG questionnaire. Our study population's mean disease duration was 8.5 +/- 6.4 years, mean Hoehn and Yahr (H&Y) clinical stage of 2.6 +/- 0.8 and mean levodopa dose of 608 +/- 375 mg/day (15 patients were not on levodopa). Twenty-six patients (32.1%) experienced FSG during the previous month and 56% of them reported that FSG was a significant and disabling symptom. FSG was strongly associated with higher stage of H&Y (p < 0.001) with a significant trend as the disease progresses (p = 0.001) but not with total score in the motor part of the Unified Parkinson's Disease Rating Scale (UPDRS). Longer disease duration was the only clinical factor, which was found to be associated with FSG in the multivariate model. Thirty seven percent (37%) of the patients with FSG reported frequent falls with association between occasional or frequent falls, as reported on the activity of daily living (ADL) part of the UPDRS, and the presence of FSG (p < 0.08). There was no association between significant postural reflex abnormalities as rated on the objective part of the UPDRS and the presence of FSG. There was a significant association between the presence of freezing of gait (FOG) as reported in the ADL part of the UPDRS and the presence of FSG (p < 0.001) as well as a significant trend towards more frequent FSG in patients with more severe FOG (p < 0.001).Conclusion: FSG was clearly associated with longer duration of PD symptoms but not with disease severity as reflected in the motor part of the UPDRS. The relationships between FSG and postural reflexes abnormalities is unclear but it is frequently associated with falls and freezing of gait. (C) 2001 Elsevier Science Ltd. All rights reserved.