Freezing when walking is observed in Parkinson's disease, secondary parkinsonism, less commonly detected in vascular disorders, hydrocephalus, multisystem atrophy and torsion dystonia. In the elderly, it is sometimes an isolated symptom. May be expressed in motor blocks during movement or inability to start movement. The cause is established according to the anamnesis, the results of a neurological examination, EEG, rheoencephalography, MRI and CT. Treatment includes dopaminergic drugs, levodopa drugs, surgical interventions.
Freezing dysbasia or freezing dysbasia is recurring episodes of inability to start or continue to move. They can be absolute (complete inability to move) or partial (steps no more than a few centimeters long or marking time). In the second case, the patient's legs practically do not move, and the body moves forward, which sometimes leads to falls. Partial freezing also includes trembling of the legs during the start or continuation of walking.
A symptom in most cases appears when you try to switch from one mode to another (start walking) or you need to change the motor program: when passing through a doorway or a narrow corridor, turning, stepping over obstacles, reaching a chair. Sometimes the external cause of freezing is not detected, the patient freezes out of the blue when moving in a straight line.
Freezing is provoked by an additional load on the brain (an attempt to make arithmetic calculations or formulate an answer to a question without stopping walking), being in the same territory with a large number of other people, the need to perform a certain action within a limited time (cross the road on a green light).
Rhythmic sound stimulation, visual cues, emotional experiences, and climbing stairs, on the contrary, temporarily reduce the severity and frequency of development of freezing dysbasia. The occurrence of a symptom is often accompanied by a loss of synergy of movements, an increase in instability when standing and walking. Freezing can occur not only when walking, but also when self-service, writing or talking.
Pathology is manifested by four main motor disorders: trembling, asymmetric muscle rigidity, hypokinesia (slowness and decrease in the number of movements, a decrease in their speed and amplitude), postural disorders. Stiffness when walking appears on average 5 years after the onset of the disease, and is more often observed in elderly patients.
The frequency and duration of episodes of freezing dysbasia increases as Parkinson's disease progresses. A clear correlation with the severity of other motor disorders cannot be found, but there is a connection with the severity of speech disorders, anxiety and depressive disorders. In severe cases, the patient cannot move without assistance.
It is a polyetiological condition, differs from Parkinson's disease by a faster increase in symptoms and symmetry of movement disorders. The clinical picture is quite variable, may not include all the symptoms characteristic of Parkinson's disease. Perhaps a combination with other cerebral manifestations: atactic gait, cerebellar syndrome, early intellectual decline. Freezing when walking and other signs of secondary parkinsonism are provoked by the following pathologies:
Walking in Parkinson's disease
Freezing when walking is characteristic of vascular parkinsonism - one of the variants of secondary parkinsonism, caused by acute and chronic disorders of cerebral circulation. The cause of the development of pathology is ischemic and hemorrhagic strokes, chronic cerebral ischemia due to cerebral atherosclerosis, arterial hypertension, SLE, vascular amyloidosis, cerebral vasculitis, periarteritis nodosa.
Typical features of this form of parkinsonism are subacute course, symmetry of disorders, the predominance of motor disorders in the lower extremities, and the early development of postural instability. The gait is constrained, shuffling, slow, small steps alternate with freezing. Mimicry is poor, gesticulation is mean or absent. Possible vascular dementia.
Most cases of drug-induced parkinsonism are associated with the use of neuroleptics. Less commonly, pathology develops during treatment with metoclopramide, sympatholytics, anticonvulsants, calcium antagonists, and some antidepressants. The disease, as a rule, debuts within 3 months from the start of drug therapy, is more often detected in elderly patients, persons with a hereditary predisposition, who are at risk (HIV, depression, strokes and TBI in history).
There is a predominance of hypokinesia, a high probability of freezing when walking. Other motor disturbances may not be expressed or mildly expressed. Cancellation of the drug in most patients entails a gradual regression of symptoms. Sometimes the phenomena of parkinsonism persist. Some patients develop Parkinson's disease after a few years.
A genetically determined disease that develops at the age of less than 20-25 years. It is characterized by symmetry of movement disorders, muscle rigidity, tremor and hypokinesia. Postural instability is less pronounced than in primary parkinsonism. Freezes are complemented by a shuffling gait, small steps, and the absence of friendly hand movements during walking. Symptoms of juvenile parkinsonism decrease in the morning and increase in the evening.
In elderly people (over 6 years old), freezing is sometimes detected as the only isolated symptom, not accompanied by other neurological disorders. The degree of impairment ranges from single smoothed episodes to severe impairments with loss of the ability to walk independently. Changes in gait gradually progress, therapy with antiparkinsonian drugs is ineffective.
Other causes of stiffness when walking include the following diseases and pathological conditions:
Neurologists are engaged in establishing the causes of the development of freezing when walking. Of great importance is the recognition of Parkinson's disease and its differentiation with various variants of secondary parkinsonism in accordance with established criteria (asymmetry of manifestations, rest tremor, progressive course, high efficacy of levodopa treatment). For the final distinction between the type of disease, the establishment of the etiology of secondary parkinsonism, the following diagnostic procedures are prescribed:
Physiotherapy
The tactics of treatment are determined taking into account the nature (primary or secondary) and the severity of parkinsonism. Medicines of the following groups are used:
Drug therapy is supplemented with exercise therapy and massage to reduce muscle rigidity, improve motor functions, maintain the ability to self-care and independent movement. In conditions after brain hypoxia, oxygen therapy is carried out.
The tactics of surgical treatment is determined by the cause of freezing in the process of walking: