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Journal of Neurology
Published in: Journal of Neurology 11/2020

Open Access 01-11-2020 | Parkinson's Disease | Review

Gait and postural disorders in parkinsonism: a clinical approach

Authors: Cecilia Raccagni, Jorik Nonnekes, Bastiaan R. Bloem, Marina Peball, Christian Boehme, Klaus Seppi, Gregor K. Wenning

Published in: Journal of Neurology | Issue 11/2020

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Abstract

Disturbances of balance, gait and posture are a hallmark of parkinsonian syndromes. Recognition of these axial features can provide important and often early clues to the nature of the underlying disorder, and, therefore, help to disentangle Parkinson’s disease from vascular parkinsonism and various forms of atypical parkinsonism, including multiple system atrophy, progressive supranuclear palsy, and corticobasal syndrome. Careful assessment of axial features is also essential for initiating appropriate treatment strategies and for documenting the outcome of such interventions. In this article, we provide an overview of balance, gait and postural impairment in parkinsonian disorders, focusing on differential diagnostic aspects.
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Literature
1.
Parkinson J (2002) An essay on the shaking palsy 1817. J Neuropsychiatry Clin Neurosci. 14(2):223–236 (discussion 2)PubMed
2.
3.
Nonnekes J, Goselink RJM, Ruzicka E, Fasano A, Nutt JG, Bloem BR (2018) Neurological disorders of gait, balance and posture: a sign-based approach. Nat Rev Neurol 14(3):183–189PubMed
4.
Nurnberger L, Klein C, Baudrexel S, Roggendorf J, Hildner M, Chen S et al (2015) Ultrasound-based motion analysis demonstrates bilateral arm hypokinesia during gait in heterozygous PINK1 mutation carriers. Mov Disord 30(3):386–392PubMed
5.
Latt MD, Lord SR, Morris JG, Fung VS (2009) Clinical and physiological assessments for elucidating falls risk in Parkinson's disease. Mov Disord 24(9):1280–1289PubMed
6.
Pickering RM, Grimbergen YA, Rigney U, Ashburn A, Mazibrada G, Wood B et al (2007) A meta-analysis of six prospective studies of falling in Parkinson's disease. Mov Disord. 22(13):1892–1900PubMed
7.
Yokochi F (2006) Lateral flexion in Parkinson's disease and Pisa syndrome. J Neurol. 253(Suppl 7):VII17–VII20PubMed
8.
9.
Marsden CD, Duvoisin R (1980) Scoliosis and Parkinson's disease. Arch Neurol 37(4):253–254PubMed
10.
Nikfekr E, Kerr K, Attfield S, Playford DE (2002) Trunk movement in Parkinson's disease during rising from seated position. Mov Disord 17(2):274–282PubMed
11.
Charlett A, Weller C, Purkiss AG, Dobbs SM, Dobbs RJ (1998) Breadth of base whilst walking: effect of ageing and Parkinsonism. Age Ageing 27(1):49–54PubMed
12.
Pistacchi M, Gioulis M, Sanson F, De Giovannini E, Filippi G, Rossetto F et al (2017) Gait analysis and clinical correlations in early Parkinson's disease. Funct Neurol 32(1):28–34PubMedPubMedCentral
13.
Mirelman A, Bernad-Elazari H, Thaler A, Giladi-Yacobi E, Gurevich T, Gana-Weisz M et al (2016) Arm swing as a potential new prodromal marker of Parkinson's disease. Mov Disord 31(10):1527–1534PubMedPubMedCentral
14.
Abdo WF, Borm GF, Munneke M, Verbeek MM, Esselink RA, Bloem BR (2006) Ten steps to identify atypical parkinsonism. J Neurol Neurosurg Psychiatry 77(12):1367–1369PubMedPubMedCentral
15.
16.
Aerts MB, Abdo WF, Bloem BR (2011) The "bicycle sign" for atypical parkinsonism. Lancet 377(9760):125–126PubMed
17.
Hely MA, Morris JG, Reid WG, Trafficante R (2005) Sydney Multicenter Study of Parkinson's disease: non-l-dopa-responsive problems dominate at 15 years. Mov Disord 20(2):190–199PubMed
18.
Kempster PA, Williams DR, Selikhova M, Holton J, Revesz T, Lees AJ (2007) Patterns of levodopa response in Parkinson's disease: a clinico-pathological study. Brain 130(Pt 8):2123–2128PubMed
19.
Rochester L, Hetherington V, Jones D, Nieuwboer A, Willems AM, Kwakkel G et al (2004) Attending to the task: interference effects of functional tasks on walking in Parkinson's disease and the roles of cognition, depression, fatigue, and balance. Arch Phys Med Rehabil 85(10):1578–1585PubMed
20.
Ebersbach G, Moreau C, Gandor F, Defebvre L, Devos D (2013) Clinical syndromes: parkinsonian gait. Mov Disord 28(11):1552–1559PubMed
21.
Factor SA (2008) The clinical spectrum of freezing of gait in atypical parkinsonism. Mov Disord 23(Suppl 2):S431–S438PubMed
22.
Contreras A, Grandas F (2012) Risk factors for freezing of gait in Parkinson's disease. J Neurol Sci 320(1–2):66–71PubMed
23.
Giladi N, McDermott MP, Fahn S, Przedborski S, Jankovic J, Stern M et al (2001) Freezing of gait in PD: prospective assessment in the DATATOP cohort. Neurology 56(12):1712–1721PubMed
24.
Giladi N, Treves TA, Simon ES, Shabtai H, Orlov Y, Kandinov B et al (2001) Freezing of gait in patients with advanced Parkinson's disease. J Neural Transm (Vienna) 108(1):53–61
25.
Giladi N, McMahon D, Przedborski S, Flaster E, Guillory S, Kostic V et al (1992) Motor blocks in Parkinson's disease. Neurology. 42(2):333–339PubMed
26.
Lamberti P, Armenise S, Castaldo V, de Mari M, Iliceto G, Tronci P et al (1997) Freezing gait in Parkinson's disease. Eur Neurol 38(4):297–301PubMed
27.
Gilat M, Lígia Silva de Lima A, Bloem BR, Shine JM, Nonnekes J, Lewis SJG (2018) Freezing of gait: promising avenues for future treatment. Parkinsonism Relat Disord 52:7–16PubMed
28.
Snijders AH, Haaxma CA, Hagen YJ, Munneke M, Bloem BR (2012) Freezer or non-freezer: clinical assessment of freezing of gait. Parkinsonism Relat Disord 18(2):149–154PubMed
29.
Nutt JG, Bloem BR, Giladi N, Hallett M, Horak FB, Nieuwboer A (2011) Freezing of gait: moving forward on a mysterious clinical phenomenon. Lancet Neurol 10(8):734–744PubMedPubMedCentral
30.
Spildooren J, Vercruysse S, Desloovere K, Vandenberghe W, Kerckhofs E, Nieuwboer A (2010) Freezing of gait in Parkinson's disease: the impact of dual-tasking and turning. Mov Disord 25(15):2563–2570PubMed
31.
Nonnekes J, Giladi N, Guha A, Fietzek UM, Bloem BR, Růžička E (2019) Gait festination in parkinsonism: introduction of two phenotypes. J Neurol 266(2):426–430PubMed
32.
Zijlmans JC, Daniel SE, Hughes AJ, Revesz T, Lees AJ (2004) Clinicopathological investigation of vascular parkinsonism, including clinical criteria for diagnosis. Mov Disord 19(6):630–640PubMed
33.
Critchley M (1929) Critical review: the nature and significance of senile plaques. J Neurol Psychopathol 10(38):124–139PubMedPubMedCentral
34.
Thompson PD, Marsden CD (1987) Gait disorder of subcortical arteriosclerotic encephalopathy: Binswanger's disease. Mov Disord 2(1):1–8PubMed
35.
Gupta D, Kuruvilla A (2011) Vascular parkinsonism: what makes it different? Postgrad Med J 87(1034):829–836PubMed
36.
Yamanouchi H, Nagura H (1997) Neurological signs and frontal white matter lesions in vascular parkinsonism. A clinicopathologic study. Stroke 28(5):965–969PubMed
37.
Demirkiran M, Bozdemir H, Sarica Y (2001) Vascular parkinsonism: a distinct, heterogeneous clinical entity. Acta Neurol Scand 104(2):63–67PubMed
38.
FitzGerald PM, Jankovic J (1989) Lower body parkinsonism: evidence for vascular etiology. Mov Disord 4(3):249–260PubMed
39.
Zijlmans JC, Poels PJ, Duysens J, van der Straaten J, Thien T, van't Hof MA et al (1996) Quantitative gait analysis in patients with vascular parkinsonism. Mov Disord. 11(5):501–508PubMed
40.
Giladi N, Kao R, Fahn S (1997) Freezing phenomenon in patients with parkinsonian syndromes. Mov Disord 12(3):302–305PubMed
41.
Wenning GK, Ben Shlomo Y, Magalhaes M, Daniel SE, Quinn NP (1994) Clinical features and natural history of multiple system atrophy An analysis of 100 cases. Brain 117(Pt 4):835–845PubMed
42.
Slawek J, Derejko M, Lass P, Dubaniewicz M (2006) Camptocormia or Pisa syndrome in multiple system atrophy. Clin Neurol Neurosurg 108(7):699–704PubMed
43.
van de Warrenburg BP, Cordivari C, Ryan AM, Phadke R, Holton JL, Bhatia KP et al (2007) The phenomenon of disproportionate antecollis in Parkinson's disease and multiple system atrophy. Mov Disord 22(16):2325–2331PubMed
44.
Kollensperger M, Geser F, Seppi K, Stampfer-Kountchev M, Sawires M, Scherfler C et al (2008) Red flags for multiple system atrophy. Mov Disord 23(8):1093–1099PubMed
45.
Geser F, Wenning GK (2007) Disproportionate antecollis: a warning sign for multiple system atrophy. Mov Disord. 22(13):1986 (author reply-7)PubMed
46.
Ricci F, De Caterina R, Fedorowski A (2015) Orthostatic hypotension: epidemiology, prognosis, and treatment. J Am Coll Cardiol 66(7):848–860PubMed
47.
Weiss A, Beloosesky Y, Grinblat J, Grossman E (2006) Seasonal changes in orthostatic hypotension among elderly admitted patients. Aging Clin Exp Res 18(1):20–24PubMed
48.
Juraschek SP, Daya N, Appel LJ, Miller ER 3rd, Windham BG, Pompeii L et al (2017) Orthostatic hypotension in middle-age and risk of falls. Am J Hypertens 30(2):188–195PubMed
49.
Shibao C, Lipsitz LA, Biaggioni I (2013) ASH position paper: evaluation and treatment of orthostatic hypotension. J Clin Hypertens (Greenwich) 15(3):147–153
50.
Gurevich T, Giladi N (2003) Freezing of gait in multiple system atrophy (MSA). Parkinsonism Relat Disord 9(3):169–174PubMed
51.
Muller J, Seppi K, Stefanova N, Poewe W, Litvan I, Wenning GK (2002) Freezing of gait in postmortem-confirmed atypical parkinsonism. Mov Disord 17(5):1041–1045PubMed
52.
Boxer AL, Yu JT, Golbe LI, Litvan I, Lang AE, Hoglinger GU (2017) Advances in progressive supranuclear palsy: new diagnostic criteria, biomarkers, and therapeutic approaches. Lancet Neurol 16(7):552–563PubMedPubMedCentral
53.
Factor SA, Jennings DL, Molho ES, Marek KL (2002) The natural history of the syndrome of primary progressive freezing gait. Arch Neurol 59(11):1778–1783PubMed
54.
Godeiro-Junior C, Felicio AC, Barsottini OG, Aguiar PM, Silva SM, Borges V et al (2008) Clinical features of dystonia in atypical parkinsonism. Arq Neuropsiquiatr 66(4):800–804PubMed
55.
Williams DR, Litvan I (2013) Parkinsonian syndromes. Continuum (Minneap Minn) 19(5 Movement Disorders):1189–1212
56.
Litvan I (1998) Progressive supranuclear palsy revisited. Acta Neurol Scand 98(6):73–84PubMed
57.
Ondo W, Warrior D, Overby A, Calmes J, Hendersen N, Olson S et al (2000) Computerized posturography analysis of progressive supranuclear palsy: a case-control comparison with Parkinson's disease and healthy controls. Arch Neurol 57(10):1464–1469PubMed
58.
Litvan I, Agid Y, Calne D, Campbell G, Dubois B, Duvoisin RC et al (1996) Clinical research criteria for the diagnosis of progressive supranuclear palsy (Steele–Richardson–Olszewski syndrome): report of the NINDS-SPSP international workshop. Neurology 47(1):1–9PubMed
59.
Nonnekes J, Aerts MB, Abdo WF, Bloem BR (2014) Medio-lateral balance impairment differentiates between Parkinson's disease and atypical parkinsonism. J Parkinson's Dis 4(4):567–569
60.
Osaki Y, Morita Y, Miyamoto Y, Furuta K, Furuya H (2017) Freezing of gait is an early clinical feature of progressive supranuclear palsy. Neurol Clin Neurosci 5(3):86–90PubMedPubMedCentral
61.
Grijalvo-Perez AM, Litvan I (2014) Corticobasal degeneration. Semin Neurol 34(2):160–173PubMed
62.
Ling H, Kovacs GG, Vonsattel JP, Davey K, Mok KY, Hardy J et al (2016) Astrogliopathy predominates the earliest stage of corticobasal degeneration pathology. Brain 139(Pt 12):3237–3252PubMed
63.
Armstrong RA (2016) Visual signs and symptoms of corticobasal degeneration. Clin Exp Optom 99(6):498–506PubMed
64.
Chahine LM, Rebeiz T, Rebeiz JJ, Grossman M, Gross RG (2014) Corticobasal syndrome: five new things. Neurol Clin Pract 4(4):304–312PubMedPubMedCentral
65.
Rinne JO, Lee MS, Thompson PD, Marsden CD (1994) Corticobasal degeneration. A clinical study of 36 cases. Brain 117(Pt 5):1183–1196PubMed
66.
Nutt JG, Marsden CD, Thompson PD (1993) Human walking and higher-level gait disorders, particularly in the elderly. Neurology 43(2):268–279PubMed
67.
Wenning GK, Litvan I, Jankovic J, Granata R, Mangone CA, McKee A et al (1998) Natural history and survival of 14 patients with corticobasal degeneration confirmed at postmortem examination. J Neurol Neurosurg Psychiatry 64(2):184–189PubMedPubMedCentral
Metadata
Title
Gait and postural disorders in parkinsonism: a clinical approach
Authors
Cecilia Raccagni
Jorik Nonnekes
Bastiaan R. Bloem
Marina Peball
Christian Boehme
Klaus Seppi
Gregor K. Wenning
Publication date
01-11-2020
Publisher
Springer Berlin Heidelberg
Published in
Journal of Neurology / Issue 11/2020
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI
https://doi.org/10.1007/s00415-019-09382-1

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