Gait disturbances in Parkinson disease. Did freezing of gait exist before levodopa? Historical review.

Gait disturbances occur frequently in advanced Parkinson's disease (PD) including slow gait, postural changes, festination and freezing of gait. We have reviewed descriptions of gait abnormalities in PD from classic predopa-literature and compared them with those found in contemporary references. Several components of gait disturbances associated with shaking palsy were very well known in classic literature. James Parkinson, Charcot, Gowers and Wilson described slowness of gait, postural changes, loss of postural reflexes and festination; according to James Parkinson, festination was a pathognomonic element in shaking palsy. In contrast, freezing of gait was rarely mentioned in historic literature save for anecdotal reports (Buzzard 1888). Freezing of gait was fully noticed after the chronic use of levodopa (Barbeau and Ambani). In this historical review, we analyze the concept, identification and evolution of gait disturbances in PD through the time.