Gait festination in Parkinson's disease

Background: Festinating gait (FSG) was first associated with parkinsonism b y Sir James Parkinson, in his original essay on "The Shaking Palsy". Its fr equency and relation to other parkinsonian features have never been assesse d. Objective: To study the relationships between gait festination and other pa rkinsonian clinical features among patients with Parkinson's disease (PD). Method: During an open lecture to patients with PD who are followed at the Movement Disorders Unit (MDU) of Tel-Aviv Sourasky Medical Center one of us explained verbally and imitated festinating gait on stage. All attending p atients with the help of their care-givers or family members, were asked to answer two written questions regarding their own experience with FSG as we ll as the degree of disability it causes. Clinical information about each p atient was taken from his/her chart at the MDU and missing data was complet ed during the next office visit or from the family physician. Statistical a nalysis was performed using t-tests for comparison between groups, Chochran -Armitage test for trends and logistic regression to assess the contributio n of age of onset, disease duration and disease severity to the development of FSG. Results: Eighty-one PD patients (58 males, mean age 67.5 +/- 10.7 years) an swered the FSG questionnaire. Our study population's mean disease duration was 8.5 +/- 6.4 years, mean Hoehn and Yahr (H&Y) clinical stage of 2.6 +/- 0.8 and mean levodopa dose of 608 +/- 375 mg/day (15 patients were not on l evodopa). Twenty-six patients (32.1%) experienced FSG during the previous m onth and 56% of them reported that FSG was a significant and disabling symp tom. FSG was strongly associated with higher stage of H&Y (p < 0.001) with a significant trend as the disease progresses (p = 0.001) but not with tota l score in the motor part of the Unified Parkinson's Disease Rating Scale ( UPDRS). Longer disease duration was the only clinical factor, which was fou nd to be associated with FSG in the multivariate model. Thirty seven percen t (37%) of the patients with FSG reported frequent falls with association b etween occasional or frequent falls, as reported on the activity of daily l iving (ADL) part of the UPDRS, and the presence of FSG (p < 0.08). There wa s no association between significant postural reflex abnormalities as rated on the objective part of the UPDRS and the presence of FSG. There was a si gnificant association between the presence of freezing of gait (FOG) as rep orted in the ADL part of the UPDRS and the presence of FSG (p < 0.001) as w ell as a significant trend towards more frequent FSG in patients with more severe FOG (p < 0.001). Conclusion: FSG was clearly associated with longer duration of PD symptoms but not with disease severity as reflected in the motor part of the UPDRS. The relationships between FSG and postural reflexes abnormalities is unclea r but it is frequently associated with falls and freezing of gait. (C) 2001 Elsevier Science Ltd. All rights reserved.