Objective: This prospective cohort study investigated the potential predictor of future FOG occurrence in patients with de novo PD.

Background: Freezing of gait (FOG) is a well-known refractory motor manifestation which is often found in advanced Parkinson’s disease (PD). It may result in frequent falling with critical physical injuries, but the pathogenesis and effective treatments are elusive.

Method: Total of 63 de novo PD patients were included in this study. All the subjects underwent brain magnetic resonance imaging (MRI), [18F] N-(3-Fluoropropyl)-2β-carbon ethoxy-3β-(4-iodophenyl) nortropane positron emission tomography (18F-FP-CIT PET), and Unified PD Rating Scales (UPDRS) at their initial diagnosis. Midbrain to pons ratio was calculated from linear measurement of both midbrain and pontine regions based on sagittal plane of individual T1 MRI. The UPDRS III was subclassified into scores of tremors, rigidity (item 22 except neck region), bradykinesia (items 23, 24, 25, and 26), and axial symptoms (items 18, 19, 22 (neck region only), 27, 28, 29, and 30). Whether a development of FOG was regularly checked up with longitudinal standard treatments.

Results: Twelve patients had developed FOG during mean follow up period of 2.8 ± 1.7 years. Postural instability, an item 30 of UPDRS III, was an effective predictor of development of FOG (Odds ratio [OR], 1.52; p < 0.001), while composite scores of axial symptoms showed trend without significance (OR, 1.38; p = 0.062). Other symptom categories including tremors, rigidity, and bradykinesia did not show any evident findings.  Subjects who encountered FOG showed smaller midbrain size than those of whom did not (midbrain to pons ratio, 0.51 (0.06) vs 0.64 (0.12), p < 0.05).

Conclusion: Our data demonstrated that early postural instability might be effective to predict future development of FOG in PD. More careful and special attention should be paid to PD patients who have early balance problems.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/early-postural-instability-is-an-effective-predictor-of-future-freezing-of-gait-in-parkinsons-disease/