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Living with Freezing of Gait: what it is, causes, and therapies

Freezing of gait is a complex and debilitating phenomenon that primarily affects people with Parkinson’s disease, but it can also be caused by other neurological diseases. This disorder manifests as a sudden inability to move, causing a sensation of “blockage” during walking.

Understanding the causes, types, and available therapeutic options is crucial to better managing these episodes and improving the quality of life for affected individuals.

Symptoms of freezing of gait

Freezing mainly manifests as a sudden inability to initiate or continue movement during walking. This phenomenon can last from a few seconds to several minutes and can occur in various situations, such as narrow passages like a doorway, walking among many people, or when the floor has different colors.

Some patients describe it as a reduction in step length to a shuffling of the feet (a phenomenon called “festination”), or as alternating leg tremors. Others describe a sensation of motor blockage, as if the feet were “glued to the floor” while the upper part of the body continues to move.

According to a study by Zhang and colleagues (2021), more than half of patients with Parkinson’s disease suffer from freezing of gait.

Freezing episodes significantly increase the risk of falls in affected individuals, with about 70% of patients reporting at least one fall per year (Wood et al, 2002).

Causes of freezing of gait

The causes of this phenomenon are still under study, but it appears that alterations in the brain circuits that control movement play a crucial role. In particular, fluctuations in dopamine levels, a neurotransmitter essential for motor control, can influence the occurrence of these episodes.

In a 2019 study conducted at the Movement Analysis Laboratory in Würzburg (Pozzi, et al.), the activity of the motor cortex and the subthalamic nucleus was recorded before, during, and after the onset of freezing. The results showed that during these episodes, patients exhibit a functional loss of connectivity between these two brain regions, as if they temporarily stop communicating. This suggests that freezing of gait may result from a communication deficit between different brain areas (circuitopathy) and not just from a lack of dopamine.

Freezing can also be triggered by various factors, cognitive and emotional situations, and environments such as approaching a narrow passage or door, dual-tasking, or the presence of many distractions. Anxiety and cognitive decline, often comorbidities of Parkinson’s disease, can exacerbate freezing of gait, making movement control more difficult.

Types of freezing of gait

This symptom can manifest in various forms, each with specific characteristics.

  • Initiation freezing occurs when the person tries to start walking from a standstill but cannot.
  • Walking freezing occurs while the person is already in motion, often coinciding with changes in direction or passing through doors, and can cause falls with serious consequences.
  • Finally, there is specific situation freezing, which occurs in particular contexts such as crowded environments or during stressful situations.

Understanding these types is crucial for developing effective management and treatment strategies.

Therapeutic options

The treatment of freezing of gait is multidisciplinary and may include a combination of medications, physiotherapy, occupational therapy, and, in some cases, surgical interventions.

  • Dopaminergic medications, such as levodopa, can help manage symptoms, although efficacy can vary from person to person, and it is known that they do not relieve the problem of freezing.
  • Physiotherapy, through specific exercise programs, can improve coordination and muscle strength, reducing the severity of freezing episodes.
  • In some cases, deep brain stimulation (DBS) can be considered to improve symptoms; however, the benefits of this invasive intervention are limited over time, as evidenced by several scientific articles.

The Gondola AMPS therapy

An effective therapeutic option for the treatment of freezing of gait is the Gondola AMPS therapy (Automated Mechanical Peripheral Stimulation). This treatment, delivered by a CE-certified medical device, consists of mechanical stimulation of two specific points on both feet, through which an impulse is sent to the brain, increasing functional connectivity in brain areas involved in movement, improving gait, balance, and fluidity of movement, thus reducing freezing episodes.

Clinical studies have shown that Gondola AMPS therapy can reduce episodes of freezing of gait, improving the quality of life for patients. Documented benefits include improved walking speed, step length, and reduced gait variability, as well as improved body rotation during movement.

The therapy is non-invasive, can be easily integrated into the daily routine, and represents a very useful therapeutic option for people affected by this disorder.

Therapeutic challenges and potential future treatments

Freezing of gait is one of the most debilitating symptoms of Parkinson’s disease, especially in the advanced stages of the disease. According to the authors of a review published in Parkinsonism and Related Disorders, current pharmacological and surgical treatments are only partially effective for many patients.

The complexity of the pathophysiology of freezing, which involves multiple neuronal circuits and cognitive deficits, makes it difficult to adapt pharmacological interventions to the specific needs of each patient.

A multidisciplinary approach that combines pharmacological and non-pharmacological treatments is considered the best option as it combines the benefits of all treatments adopted to reduce the symptoms of the disease.

Gondola AMPS therapy can be a valuable addition to existing therapies, improving the overall efficacy of treatment. Integrating Gondola AMPS with traditional pharmacological and rehabilitative therapies can allow for personalized treatment based on the specific needs of each patient, also providing greater stability during gait and more effective management of freezing of gait.

Tips for preventing and managing freezing episodes

Freezing of gait represents a significant challenge for many people with Parkinson’s, but with a thorough understanding of the symptoms, causes, and available therapeutic options, it is possible to improve quality of life.

Through a combination of medical treatments, physiotherapy, and practical strategies, patients can find effective ways to manage this condition and maintain their independence.

Maintaining good posture and wearing appropriate shoes can reduce the risk of new episodes.

When a freezing episode occurs, it is important to stay calm and try to restore the walking rhythm by stopping and restarting with the first step a little longer than usual.

Gondola AMPS therapy offers a new effective option, seamlessly integrating with traditional therapies and providing a non-invasive option to improve movement management.

 

References

  • Perez-Lloret S, Negre-Pages L, Damier P, et al. Prevalence, determinants, and effect on quality of life of freezing of gait in Parkinson disease. JAMA Neurol. 2014;71(7):884-890. doi:10.1001/jamaneurol.2014.753
  • Wood BH, Bilclough JA, Bowron A, Walker RW. Incidence and prediction of falls in Parkinson’s disease: a prospective multidisciplinary study. J Neurol Neurosurg Psychiatry. 2002;72(6):721-725. doi:10.1136/jnnp.72.6.721
  • Zhang WS, et al. Prevalence of freezing of gait in Parkinson’s disease: a systematic review and meta-analysis [published correction appears in J Neurol. 2021 Aug 24;:]. J Neurol. 2021;268(11):4138-4150. doi:10.1007/s00415-021-10685-5
  • Pozzi NG, Canessa A, Palmisano C, et al. Freezing of gait in Parkinson’s disease reflects a sudden derangement of locomotor network dynamics. Brain. 2019;142(7):2037-2050. doi:10.1093/brain/awz141

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