Objective: To present a unique case in which trihexyphenidyl was used as an effective treatment to dramatically reduce freezing of gait (FoG) in a Parkinson’s disease (PD) patient who was unable to tolerate dopamine replacement therapy.

Background: Freezing of gait (FoG) in Parkinson’s disease (PD) results from dysfunction in the basal ganglia-thalamocortical and brainstem locomotor circuits, leading to impairments in movement initiation, sensory-motor integration, and cognitive control. Unfortunately, FoG is often resistant to standard treatments, including dopaminergic therapy, cueing strategies, physical therapy, and deep brain stimulation (DBS), all of which aim to mitigate these dysfunctions and improve mobility.

Method: A case report detailing the clinical presentation, response to treatment, and results from a dopamine transporter (DAT) scan and brain magnetic resonance imaging (MRI).

Results: A 76-year-old man with an 8-year history of Parkinson’s disease, confirmed by a positive DAT scan, had severe, medication-refractory freezing of gait (FoG) for two years, leading to mobility impairment and SNF placement. Prior treatments—including Sinemet, Rotigotine, Ropinirole, Clonazepam, Amantadine, and Rasagiline—were ineffective and caused additional symptoms like tremors and fatigue. Sensory cues provided no benefit.

Following trihexyphenidyl (Artane) treatment, he showed marked FoG improvement. With titration to 2 mg TID, he experienced sustained symptom relief, enabling SNF discharge and eliminating wheelchair dependence.

Conclusion: To date, no published case studies have demonstrated significant improvement in a patient’s freezing of gait (FoG) with trihexyphenidyl (Artane), except for a single case reported in 2020 (1). That study described a patient with a FoG-like gait disturbance characterized by direction-associated FoG occurring exclusively during forward walking, who experienced gait improvement with trihexyphenidyl. However, the patient’s leg symptoms were more consistent with task-specific dystonia, as subsequent surface electromyography (EMG) studies revealed dystonic co-contraction in the leg during forward walking in the OFF-state, but not during backward walking or side-stepping, supporting a diagnosis of task-specific dystonia.

References: 1. Shimo, Y., Hatano, T., Sakurai, M. et al. Freezing of gait in Parkinson’s disease may share the mechanisms of dystonia. Neurol Sci 41, 1285–1286 (2020). https://doi.org/10.1007/s10072-019-04155-0

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MDS Abstracts - https://www.mdsabstracts.org/abstract/trihexyphenidyl-as-a-treatment-for-severe-freezing-of-gait-in-parkinsons-disease-a-case-report/