Improved treatment recommendations for freezing of gait

Freezing of gait is a common and debilitating motor symptom that commonly occurs in person’s with Parkinson disease (PD), atypical parkinsonism and other neurodegenerative conditions. Ten years ago, a treatment algorithm for freezing of gait was proposed by Radboudumc doctors, together with international colleagues. This guideline is now widely being used in daily clinical practice. However, knowledge of the mechanisms that underlie freezing of gait has advanced considerably since, and novel treatments have emerged.

Jorik Nonnekes (associate professor and consultant in rehabilitation medicine) therefore took the initiative to present a revised guidance for the management of freezing of gait on the basis of the latest insights into the underlying pathophysiology. Together with a group of international experts, among Anouk Tosserams and Bas Bloem, the team published these recommendations last week in Nature Reviews Neurology.

Management of freezing of gait requires a multifaceted approach that includes pharmacological, surgical and non-pharmacological interventions. The team proposed two complementary treatment flows, both of which are linked to the pathophysiology and tailored to specific freezing of gait phenotypes. The first workflow focuses on the reduction of excessive inhibitory outflow from the basal ganglia through use of dopaminergic medication or advanced therapies such as deep brain stimulation and infusion therapy. The second workflow focuses on facilitation of processing across cerebral compensatory networks by use of non-pharmacological interventions. Importantly, the paper also highlights potential targets for preventive approaches.

The publication will most likely help clinicians to make treatment decisions, thereby improving the mobility and quality of life of individuals with freezing of gait. Moreover, the contribution will inspire researchers to conduct well-designed clinical trials of treatments for freezing of gait and will inform the design of trials for prevention of gait freezing.

The article is linked to research program Parkinson’s disease and other movement disorders

About the publication

Management of freezing of gait - mechanism-based practical recommendations

Anouk Tosserams, Alfonso Fasano, Moran Gilat, Stewart A Factor, Nir Giladi, Simon J G Lewis, Caroline Moreau, Bastiaan R Bloem, Alice Nieuwboer, Jorik Nonnekes