Abstract Details

Title Levodopa Unresponsive Freezing of Gait: Defining the Gait and Non-motor Phenotype

Topic Movement Disorders

Presentation(s) Movement Disorders Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 082

Objective To determine which gait and non-motor features differentiate between Parkinson’s patients with levodopa responsive and unresponsive gait freezing.

Background Levodopa-unresponsive gait freezing is a debilitating feature of Parkinson’s disease without treatment options. Freezing leads to decreased mobility, falls, and decreased quality of life. The phenotype of levodopa-unresponsive gait freezing patients has not been defined.

Design/Methods Continuous gait was collected in the levodopa-medicated state using an instrumented gait mat in 105 patients. Motor and non-motor disease features were assessed using validated rating scales. A linear mixed model with age, sex, disease duration and motor Unified Parkinson’s disease rating scale (mUPDRS) scores as covariates was used to determine group differences in spatiotemporal gait parameters between levodopa-unresponsive and responsive-freezers as well as non-freezers and levodopa-responsive-freezers.

Results Disease severity in levodopa-unresponsive-freezers was 10.5 points (95% CI: 6.0-15.0) greater than in levodopa-responsive-freezers on the mUPDRS, and Montreal Cognitive Assessment Scores were 3.8 points (95% CI: 1.8-5.9) lower, but mood and sleep quality, as well as disease duration, were similar between the two groups. For parameters that were statistically significant between the levodopa-responsive-freezers and non-freezers (mean stance-percent, total-double-support-percent, stride-length and stride-velocity; percent step-to-step variability in foot-strike and stance-percent), differences between levodopa-unresponsive and responsive-freezers were at least as large and in the opposite direction. The lack of statistical significance was likely due to levodopa-unresponsive-freezers having greater between subject variability in measured gait parameters. The group differences showed no dependence on disease severity tested using mUPDRS tertiles. Disease asymmetry measured as the ratio of the more effected to less effected side was not different between the group pairs.

Conclusions Though variability in levodopa-unresponsive-freezers was much greater than in the other two groups, continuous gait deficits may prove useful in distinguishing levodopa-responsive from unresponsive-freezers independent of disease severity.

Authors/Disclosures
Tuhin Virmani, MD, PhD, F�鶹��ýӳ�� (University of Arkansas for Medical Sciences) PRESENTER	The institution of Dr. Virmani has received research support from Parkinson's Foundation.
	No disclosure on file
Aliyah J. Glover (UAMS Neurology)	Miss Glover has nothing to disclose.
Lakshmi Pillai (University of Arkansas for Medical Sciences Little RoCK)	Ms. Pillai has nothing to disclose.
Shannon Doerhoff, NP (UAMS)	Shannon Doerhoff has nothing to disclose.

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