Objective: To evaluate the relation between motor symptoms asymmetry in patients with Parkinson’s disease (PD) and freezing of gait (FOG) episodes.

Background: It is yet unsettled whether the first leg to ‘freeze’ during a FOG episode is preferentially of the predominantly affected body side, or whether initiation of freezing is influenced by motor asymmetry towards the more or less affected leg.

Method: 18 PD participants (age: 64.4±7.9 years, 6 females) suffering from FOG performed over-ground gait trials including:  1) Walking with turning, i.e., ~15 m back and forth corridor walking  with 180⁰ turns both to the right and to the left at the edges; 2) passing through narrow passages; and 3) walking along figure 8 shaped trajectories. The trials took place during the off medication phase and were documented on video recordings. The more affected (MA) and less affected (LA) body side was determined according to part III MDS-UPDRS data. The total number of FOG events, turn directions, and the leg first to freeze (first foot not to pass the contralateral foot), were identified by post-hoc video inspections. For each participant who exhibited FOG (14/18) we calculated the following outcomes: percentage of FOG episodes which started with the MA side (%MA-FOG); the percentage of FOG episodes occurring when turning was to the direction of the MA side, percentage of %MA-FOG correspondingly to turning direction or during gait initiation.

Results: Totally, 282 FOG episodes were identified by video inspection. The mean value of %MA-FOG (±SD) was 67.8 ± 25.2% (range: 26.7-100%), significantly higher than the proportions of FOG episodes which start with the less-affected side (32.2±25.2%; range: 0-73%; p=.026).  During figure 8 shaped walking the participants (n=11; exhibited total of 72 FOG episodes) performed on average 8.9±9.2 turns towards the MA side (range: 2-29) and 9.5±9.3 turns to the LA side (range: 1-28). No difference was found in terms of the number of FOG episodes per turn, when turns were toward the MA side (51.9 ± 52.7%, range: 0-150%) as compared to turns towards the LA side (49.6±53.5%, range: 0-129%; p=.95).

Conclusion: Supporting previous results, we found that FOG more often starts with the freeze of the leg of the more symptomatic side. Nonetheless, turning towards this side did not increase FOG propensity, emphasizing that bilaterally differentiated gait kinematics required during turning lead to FOG rather than side symptomology.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/motor-asymmetry-in-parkinsons-disease-relation-with-freezing-of-gait/