Gait festination in Parkinson's disease

Abstract

Background: Festinating gait (FSG) was first associated with parkinsonism by Sir James Parkinson, in his original essay on “The Shaking Palsy”. Its frequency and relation to other parkinsonian features have never been assessed. Objective: To study the relationships between gait festination and other parkinsonian clinical features among patients with Parkinson's disease (PD). Method: During an open lecture to patients with PD who are followed at the Movement Disorders Unit (MDU) of Tel-Aviv Sourasky Medical Center one of us explained verbally and imitated festinating gait on stage. All attending patients with the help of their care-givers or family members, were asked to answer two written questions regarding their own experience with FSG as well as the degree of disability it causes. Clinical information about each patient was taken from his/her chart at the MDU and missing data was completed during the next office visit or from the family physician. Statistical analysis was performed using t-tests for comparison between groups, Chochran–Armitage test for trends and logistic regression to assess the contribution of age of onset, disease duration and disease severity to the development of FSG. Results: Eighty-one PD patients (58 males, mean age 67.5±10.7 years) answered the FSG questionnaire. Our study population's mean disease duration was 8.5±6.4 years, mean Hoehn and Yahr (H&Y) clinical stage of 2.6±0.8 and mean levodopa dose of 608±375 mg/day (15 patients were not on levodopa). Twenty-six patients (32.1%) experienced FSG during the previous month and 56% of them reported that FSG was a significant and disabling symptom. FSG was strongly associated with higher stage of H&Y ( p<0.001) with a significant trend as the disease progresses ( p=0.001) but not with total score in the motor part of the Unified Parkinson's Disease Rating Scale (UPDRS). Longer disease duration was the only clinical factor, which was found to be associated with FSG in the multivariate model. Thirty seven percent (37%) of the patients with FSG reported frequent falls with association between occasional or frequent falls, as reported on the activity of daily living (ADL) part of the UPDRS, and the presence of FSG ( p<0.08). There was no association between significant postural reflex abnormalities as rated on the objective part of the UPDRS and the presence of FSG. There was a significant association between the presence of freezing of gait (FOG) as reported in the ADL part of the UPDRS and the presence of FSG ( p<0.001) as well as a significant trend towards more frequent FSG in patients with more severe FOG ( p<0.001). Conclusion: FSG was clearly associated with longer duration of PD symptoms but not with disease severity as reflected in the motor part of the UPDRS. The relationships between FSG and postural reflexes abnormalities is unclear but it is frequently associated with falls and freezing of gait.