Freezing während des Gehens

Phänomen, Pathophysiologie, Therapie

Freezing of gait

Phenomenology, pathophysiology, and therapeutic approaches

Zusammenfassung

Freezing während des Gehens ist beim idiopathischem Parkinson-Syndrom und anderen zentralen Gangstörungen häufig. Bei den meisten Patienten tritt es im späteren Verlauf der Erkrankung auf. Vor dem Beginn der Therapie mit Levodopa kann es aber auch das frühe Krankheitsbild prägen. Freezing beim Gehen besitzt eine eigene spezifische Pathophysiologie und ist nicht der Bradykinese zuzuordnen. Es kommt sowohl während On- als auch während Off-Phasen vor. Es reduziert die Mobilität, beeinträchtigt Aktivitäten im täglichen Leben und ist eine bedeutende Ursache für Stürze. On-Freezing lässt sich durch Pharmakotherapie und tiefe Hirnstimulation nur unzureichend beeinflussen. Der Einsatz externer Schrittmacher kann Freezing und Festination hingegen wirkungsvoll reduzieren. Schrittmacher können akustisch, visuell, taktil oder mental dargeboten werden. Der vorliegende Artikel diskutiert die zu Verfügung stehenden pharmakologischen und physiotherapeutischen Therapieoptionen.

Abstract

Freezing of gait (FOG) is a common disturbance in Parkinson’s disease (PD) and other higher-level gait disorders. It appears most often during the later stages of PD but is seen also during the initial phases before oral substitution of levodopa has started. The disorder has its own pathophysiology and differs from bradykinesia. It can occur both on and off medication. It interferes with activities of daily life, reduces mobility, and is an important risk factor for falling. While patients with FOG during medication do not reliably respond to pharmacotherapy or deep brain stimulation, external cues have been demonstrated that influence FOG effectively. They are applied as auditory, visual, tactile, or mental cues. This article discusses available pharmacological and physiotherapeutic approaches to the treatment of FOG.

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Correspondence to Prof. Dr. A. Ceballos-Baumann.

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Schroeteler, F., Ziegler, K., Fietzek, U. et al. Freezing während des Gehens. Nervenarzt 80, 693–699 (2009). https://doi.org/10.1007/s00115-009-2670-z

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Schlüsselwörter

  • Motorische Blockaden
  • Parkinson-Syndrome
  • Pathophysiologie
  • Therapieoptionen

Keywords

  • Freezing of gait
  • Parkinson’s disease
  • Pathophysiology
  • Therapeutic approaches