Understanding and treating freezing of gait in parkinsonism, proposed working definition, and setting the stage
Understanding and treating freezing of gait in parkinsonism, proposed working definition, and setting the stage
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DOI：
10.1002/mds.21927
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发表时间：
2008-01-01
影响因子：
8.6
通讯作者：
Nieuwboer, Alice
中科院分区：
文献类型：
--
作者：
Giladi, Nir;Nieuwboer, Alice
虽然早期的作者没有使用过“步态冻结”（FOG）这个术语，尤其是帕金森本人也没有使用过，但他将与这种步态障碍相关的典型推进性高频步进描述为帕金森病（PD）的一个特征。Martin2还报告了脑炎后帕金森症患者无法启动运动并伴有对视觉提示的剧烈反应的步态紊乱的例子。直到20世纪70年代初，FOG才开始受到越来越多的关注，因为人们意识到它对左旋多巴的反应比运动迟缓和僵硬更复杂。在早期，人们首次提出左旋多巴有时会诱发甚至恶化FOG。3基于这些报告和FOG在非典型帕金森综合征中的发生，长期以来一直被认为是左旋多巴耐药症状。我花了30年的左旋多巴治疗经验才明白这是一种误解。Schaafsma等人证明，当从“关闭”转为“打开”时，“关闭”相关FOG发作的持续时间明显缩短，频率明显减少。4然而，与左旋多巴治疗的复杂关系的概念仍然成立，这一点可以通过FOG在“on”期间的持续表现及其与其他左旋多巴耐药症状（如姿势不稳定）的关系得到证明。第五、六条
Although the term “freezing of gait”(FOG) was not used by early authors and notably not by Parkinson himself, 1 the typical propulsive high frequency stepping associated with this gait disturbance was described by him as a feature of Parkinson’s disease (PD). Martin2 also reported examples of an inability to initiate locomotion accompanied by disturbed stepping patterns in postencephalitic parkinsonism with a dramatic response to visual cues. It was not until the early 1970s that FOG started to get increased attention, based on the realization that its response to levodopa was more complex than that of bradykinesia and rigidity. During those early days, it was first suggested that levodopa can sometimes induce or even worsen FOG. 3 Based on those reports and the occurrence of FOG in atypical parkinsonism, it has long been considered a levodopa-resistant symptom. It took 30 years of experience with levodopa treatment to understand that this is a misconception. Schaafsma et al. demonstrated that “off”-related FOG episodes were significantly shorter in duration and markedly fewer in frequency when turning from “off” to “on.” 4 However, the concept of a complex relationship with levodopa treatment still holds, as is evidenced by the continued manifestation of FOG in the “on” period, and its relationship with other levodopa-resistant symptoms such as postural instability. 5, 6