Management of gait impairments in Parkinson's disease

Abstract

Gait disorders are among the most frequent disorders that can impair functional independence and quality of life in patients with movement disorders, such as Parkinson's disease (PD). The core manifestation of gait disorders in PD is a “bradykinetic/hypokinetic gait,” which is characterized by reduced stride length, step width, and gait speed. The leg lifting height and arm swing are also reduced. Additionally, gait asymmetry is observed as seen in other movement disorders. Patients with advanced PD may develop freezing of gait (FOG) and a festinating gait. L–dopa is the standard pharmacotherapy for gait disorders in PD. It has been reported that L–dopa can extend the range of motion of the pelvis and lower limb joints and improve stride length and gait speed. However, the effects of L–dopa on gait parameters are inconsistent and its effects on postural control are limited. In addition, cholinesterase inhibitors has been reported to decrease the incidence of falls in PD patients with a history of falls. The dose adjustment of antiparkinsonian drugs such as L–dopa and management of wearing–off are the first–line therapy for FOG. The dose of L–dopa is set considering that the treatment threshold for FOG may be higher than that for other movement symptoms. Recently, istradefylline has been reported to be effective in reducing FOG in patients with advanced PD who are refractory to conventional therapy.