Improvement with Duloxetine in Primary Progressive Freezing Gait

Abstract

Primary progressive freezing gait (PPFG) is a rare progressive neurologic disorder that primarily affects gait, initially resulting in freezing of gait (FOG) and later in postural instability, without other typical parkinsonian features.1 Response to dopaminergic medications is poor, and no satisfactory treatment is yet available for this condition.1 We now report that duloxetine, a new serotonin and norepinephrine reuptake inhibitor (SNRI), provides sustained improvement in a patient with PPFG. ### Level of evidence. This case report provides Class IV evidence that duloxetine, 60 mg/day, decreased the number and severity of FOG episodes in PPFG disorder. ### Case report. A 58-year-old man came to our attention, complaining of progressive gait difficulties that had started 10 months before and led to falls and fear of falling. At our first examination, he presented with FOG consisting mainly of start hesitation, turning hesitation, and narrow hesitation, which deeply affected his daily activities as revealed by a FOG questionnaire (FOG-Q) score of 18 of 242 (video, segment A, on the Neurology ® Web site at www. neurology.org). Cutaneous plantar responses were in extension bilaterally, and he had postural instability. …