E–Pearl of the Week: Freezing of gait in Parkinson disease: Not just during "off states"

February 15, 2012


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February 14, 2012

Freezing of gait in Parkinson disease: Not just during "off states"

Freezing of gait in an “off” state in patients with Parkinson disease is well recognized. Pronounced during turns and gait initiation, this symptom improves with dopaminergic medications. Less well known is the freezing of gait during the “on” state that more rarely occurs as a paradoxical complication of levodopa.  Some characteristics that may help differentiate these is that “on” state freezing of gait worsens with increasing levodopa doses, occurs during open space walking just as often as during turning or initiation, and is associated with good control of other parkinsonian features.


1. Espay AJ, Fasano A, van Nuenen BFL, Payne MM, Snijders AH, Bloem BR. “On” state freezing of gait in Parkinson disease: A paradoxical levodopa–induced complication. Neurology 2012; 78: 454–457.

2. Ambani LM, Van Woert MH. Start hesitation–a side effect of long–term levodopa therapy. N Engl J Med 1973; 288: 1113–1115.

Submitted by: Jennifer E. Fugate, D.O.

Disclosures: Dr. Fugate serves on the editorial team for the Neurology® Resident and Fellow Section.

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