Sahyli Perez Parra1, J Lucas McKay2, Stewart A Factor1. 1. Jean & Paul Amos PD & Movement Disorders Program Department of Neurology Emory University Atlanta Georgia USA. 2. Wallace H. Coulter Department of Biomedical Engineering Georgia Tech and Emory University Atlanta Georgia USA.
Abstract
BACKGROUND: The relationship between freezing of gait (FOG) and levodopa response is complex. Some patients respond, some have no response and in some patients levodopa causes FOG. We present 2 cases demonstrating a diphasic worsening of FOG after levodopa dosing. CASES: Two PD patients with FOG were examined during the practically defined off state, the transition from off to on (15 and 22 minutes postdose), and in the full on state (45 and 60 minutes postdose). FOG was measured using Movement Disorder Society-Unified Parkinson's Disease Rating Scale part III, item 11: freezing of gait. Both patients experienced worsening of FOG during the transition followed by improvement during the on state. Case 1 had serum levodopa levels measured. Videos are provided. CONCLUSIONS: To our knowledge, this diphasic pattern of worsening of FOG has not been previously reported. The cause of this phenomenon is unknown but may relate to an inhibitory action of subthreshold levels of levodopa.
BACKGROUND: The relationship between freezing of gait (FOG) and levodopa response is complex. Some patients respond, some have no response and in some patients levodopa causes FOG. We present 2 cases demonstrating a diphasic worsening of FOG after levodopa dosing. CASES: Two PD patients with FOG were examined during the practically defined off state, the transition from off to on (15 and 22 minutes postdose), and in the full on state (45 and 60 minutes postdose). FOG was measured using Movement Disorder Society-Unified Parkinson's Disease Rating Scale part III, item 11: freezing of gait. Both patients experienced worsening of FOG during the transition followed by improvement during the on state. Case 1 had serum levodopa levels measured. Videos are provided. CONCLUSIONS: To our knowledge, this diphasic pattern of worsening of FOG has not been previously reported. The cause of this phenomenon is unknown but may relate to an inhibitory action of subthreshold levels of levodopa.
Authors: Manuel Alegre; Jon López-Azcárate; Fernando Alonso-Frech; Maria C Rodríguez-Oroz; Miguel Valencia; Jorge Guridi; Julio Artieda; José A Obeso Journal: Mov Disord Date: 2012-06-28 Impact factor: 10.338
Authors: M Amboni; F Stocchi; G Abbruzzese; L Morgante; M Onofrj; S Ruggieri; M Tinazzi; M Zappia; M Attar; D Colombo; L Simoni; A Ori; P Barone; A Antonini Journal: Parkinsonism Relat Disord Date: 2015-04-13 Impact factor: 4.891
Authors: S A Factor; M K Scullin; A B Sollinger; J O Land; C Wood-Siverio; L Zanders; A Freeman; D L Bliwise; F C Goldstein Journal: Parkinsonism Relat Disord Date: 2014-09-28 Impact factor: 4.891
Authors: Alberto J Espay; Francesca Morgante; Aristide Merola; Alfonso Fasano; Luca Marsili; Susan H Fox; Erwan Bezard; Barbara Picconi; Paolo Calabresi; Anthony E Lang Journal: Ann Neurol Date: 2018-11-30 Impact factor: 10.422
Authors: J Lucas McKay; Felicia C Goldstein; Barbara Sommerfeld; Douglas Bernhard; Sahyli Perez Parra; Stewart A Factor Journal: NPJ Parkinsons Dis Date: 2019-11-22
Authors: Simon Lewis; Stewart Factor; Nir Giladi; Alice Nieuwboer; John Nutt; Mark Hallett Journal: Transl Neurodegener Date: 2022-05-01 Impact factor: 9.883