Objective: To determine which spatiotemporal gait parameters respond to levodopa in Parkinson’s patients with levodopa ON- and OFF-state gait freezing.
Background: Levodopa-ON-state gait freezing is a debilitating feature of Parkinson’s disease with limited treatment options. Freezing leads to decreased mobility, falls, and decreased quality of life.
Method: Continuous gait was collected using a gait mat in both the effective levodopa OFF-state (doses withheld >8 hours) and ON-state (1 hour after dose), in 32 people with Parkinson’s disease with freezing of gait. Participants whose freezing resolved with levodopa were classified as OFF-freezers (n=10) while those whose freezing continued with levodopa were classified as ON-freezers (n=22). The mean and variability in stride-length, stride-time, stride-width, stride-velocity, foot-strike-length, swing-phase-percent and total-double-support-percent were determined. A repeated measures analysis of variance was used to estimate the levodopa response.
Results: Participants had a mean age of 70.5 ± 8.0 years, disease duration of 10.4 ± 4.6 years and freezing of gait for 4.1 ± 2.2 years. Both ON- and OFF-freezers showed improvement in mean stride-length [ON-freezers: +10.3cm (95%CI: 2.2–18.4cm); OFF-freezers: +13.9cm (95%CI: 3.1–22.0cm)], and stride-velocity [ON-freezers: +9.8cm/s (95%CI: 3.1–16.6cm/s); OFF-freezers: +11.7cm/s (95%CI: 4.1–19.2cm/s)] with levodopa. OFF- but not ON-freezers, also had improved foot-strike-length [+1.0cm (95%CI: 0.3–1.6cm)], swing-percent [+0.9% (95%CI: 0.2–1.7%)] and total-double-support-percent [-1.6% (95%CI: -3.1– -0.1%)]. Stride-time and stride-width were not significantly levodopa responsive in either type of freezer. There were no group × levodopa interaction effects. Variability measures were not significantly levodopa responsive in freezers.
Conclusion: Like OFF-freezers, ON-freezers showed improved stride-length and stride-velocity with levodopa. Modulation of foot-strike-length and swing- and total-double-support, which improved only in OFF-freezers, could play a role in ON-freezing development and treatment. Titration of levodopa using objective measures to optimize gait, may be beneficial in difficult to treat patients.
To cite this abstract in AMA style:T. Virmani, L. Pillai, A. Glover, R. Landes. Levodopa responsive gait dynamics in ON- and OFF-state freezing of gait in Parkinson’s disease [abstract]. Mov Disord. 2021; 36 (suppl 1). https://www.mdsabstracts.org/abstract/levodopa-responsive-gait-dynamics-in-on-and-off-state-freezing-of-gait-in-parkinsons-disease/. Accessed December 7, 2023.
« Back to MDS Virtual Congress 2021
MDS Abstracts - https://www.mdsabstracts.org/abstract/levodopa-responsive-gait-dynamics-in-on-and-off-state-freezing-of-gait-in-parkinsons-disease/