Perez Parra Sahyli, McKay J Lucas, Factor Stewart A
Jean & Paul Amos PD & Movement Disorders Program Department of Neurology Emory University Atlanta Georgia USA.
Wallace H. Coulter Department of Biomedical Engineering Georgia Tech and Emory University Atlanta Georgia USA.
Mov Disord Clin Pract. 2020 Mar 9;7(3):325-328. doi: 10.1002/mdc3.12918. eCollection 2020 Apr.
The relationship between freezing of gait (FOG) and levodopa response is complex. Some patients respond, some have no response and in some patients levodopa causes FOG. We present 2 cases demonstrating a diphasic worsening of FOG after levodopa dosing.
Two PD patients with FOG were examined during the practically defined state, the transition from to (15 and 22 minutes postdose), and in the full state (45 and 60 minutes postdose). FOG was measured using Movement Disorder Society-Unified Parkinson's Disease Rating Scale part III, item 11: freezing of gait. Both patients experienced worsening of FOG during the transition followed by improvement during the state. Case 1 had serum levodopa levels measured. Videos are provided.
To our knowledge, this diphasic pattern of worsening of FOG has not been previously reported. The cause of this phenomenon is unknown but may relate to an inhibitory action of subthreshold levels of levodopa.
冻结步态（FOG）与左旋多巴反应之间的关系很复杂。一些患者有反应，一些患者无反应，还有一些患者左旋多巴会引发冻结步态。我们报告2例患者，其在服用左旋多巴后出现冻结步态双相性加重。
对2例有冻结步态的帕金森病患者在实际定义的状态下进行检查，即从起始状态到转换状态（给药后15分钟和22分钟），以及在完全开启状态（给药后45分钟和60分钟）。使用运动障碍协会统一帕金森病评定量表第三部分第11项：冻结步态来测量冻结步态。2例患者在转换过程中冻结步态均加重，随后在完全开启状态下改善。对病例1测量了血清左旋多巴水平。提供了视频。
据我们所知，此前尚未报道过这种冻结步态双相性加重模式。这种现象的原因尚不清楚，但可能与低于阈值水平的左旋多巴的抑制作用有关。
