Klucken Jochen, Winkler Juergen, Krüger Rejko, Jost Wolfgang
Molekulare Neurologie, Universitätsklinikum Erlangen; Fraunhofer-Institut für Integrierte Schaltungen IIS, Erlangen; Medical Valley Digital Health Application Center, Bamberg.
Molekular-Neurologische Abteilung, Universitätsklinikum Erlangen.
Fortschr Neurol Psychiatr. 2020 Sep;88(9):573-581. doi: 10.1055/a-1227-6258. Epub 2020 Sep 21.
The background of the freezing-of-gait (FOG) phenomenon in Parkinson's syndrome is presented in this review. The following issues are addressed: characterization of the symptom freezing and its subtypes that challenge standardized diagnostic procedures; available assessment methods generating freezing-related parameters that not only support clinical studies but can also be applied in everyday care, and current therapy options. FOG exists in different subtypes, and clinical and diagnostic definitions are limited by subjective characterization and semi-standardized tests. FOG-specific drug options are not existing, apart from the optimization of dopaminergic medication, which may also be due to the poor discriminatory power of standardized diagnostics. This is also true for deep brain stimulation. Both of these therapeutic options may be due not only to the complex neural network alterations as a motor-control correlate of FOG, but also because of challenging diagnostic assessments methodologies. Innovative, wearable, sensor-based diagnostic strategies are currently being developed, and supportive therapies using tools and technologies focusing on 'cueing' are becoming increasingly well accepted. Even though high level evidence is missing, they provide a helpful treatment option for individualized therapy. It can be assumed that these options will become particularly popular due to technological progress and likely alter the everyday treatment challenges faced by doctors and therapists.
本综述介绍了帕金森综合征中冻结步态(FOG)现象的背景。讨论了以下问题:症状冻结及其亚型的特征,这些特征对标准化诊断程序构成挑战;现有的评估方法可生成与冻结相关的参数,这些参数不仅支持临床研究,还可应用于日常护理,以及当前的治疗选择。FOG存在不同亚型,临床和诊断定义受主观特征描述和半标准化测试的限制。除了优化多巴胺能药物治疗外,目前尚无针对FOG的特定药物选择,这也可能是由于标准化诊断的鉴别能力较差所致。深部脑刺激也是如此。这两种治疗选择可能不仅是因为作为FOG运动控制相关因素的复杂神经网络改变,还因为具有挑战性的诊断评估方法。目前正在开发创新的、可穿戴的、基于传感器的诊断策略,使用专注于“提示”的工具和技术的支持性疗法越来越被广泛接受。尽管缺乏高水平证据,但它们为个体化治疗提供了有益的治疗选择。可以设想,由于技术进步,这些选择将变得特别受欢迎,并可能改变医生和治疗师面临的日常治疗挑战。