Objective: To describe high step marching dyskinesia in two patients with Parkinson’s disease (PD)

Background: Levodopa-induced dyskinesias can interfere with gait in patients with Parkinson’s disease. A limited number of case reports describe dyskinetic-dystonic gait patterns, including stamping or marching gait as well as the “marionette walk” [1, 2].

Method: We describe two patients with Parkinson’s disease with high step marching dyskinesia.

Results: Patient 1 developed left upper extremity stiffness at age 54 and was diagnosed with PD at age 57. Ten years after symptom onset, she developed an intermittent and striking gait change consisting of large amplitude involuntary left hip and knee flexion movements triggered by walking with a high step marching appearance in the left leg only. There were additional elements of ankle inversion and plantarflexion, which also occurred in a seated position. These involuntary movements occurred when wearing off levodopa (several hours after 1.5 tablets carbidopa/levodopa 25/100 mg), supportive of a biphasic pattern of dyskinesia. Symptoms were worsened by levodopa dose increase but improved with the addition of extended-release amantadine.

Patient 2 developed motor signs of parkinsonism at age 47 and received a diagnosis of PD two years later. Five years after symptom onset, he developed a high step marching pattern to his gait consisting of involuntary exaggerated hip flexion in the right leg along with external hip rotation, triggered specifically by walking. The high step marching gait pattern was noted to occur variably when wearing off levodopa with re-emergence of severe rest tremor, but also in peak-dose periods. The movements improved with levodopa dose reduction and addition of amantadine.

Conclusion: These cases of an involuntary high-step marching gait pattern contribute to the growing body of literature on phenotypic variations in motor fluctuations and dyskinesia affecting gait in Parkinson’s disease. Caution should be taken to avoid misdiagnosing dyskinetic gait patterns as functional movement disorders.

References: 1. Avenali M, Vaghi G, De Icco R, et al. Pearls & Oy-sters: Marionette Walk in Parkinson Disease. Neurology. 2022;99(2):77-81. doi:10.1212/WNL.0000000000200714
2. Růžička E, Zárubová K, Nutt JG, Bloem BR. “Silly walks” in Parkinson’s disease: unusual presentation of dopaminergic-induced dyskinesias. Mov Disord. 2011;26(9):1783-1784. doi:10.1002/mds.23667

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MDS Abstracts - https://www.mdsabstracts.org/abstract/high-step-marching-dyskinesia-a-case-series/