March freezing is a complex and debilitating phenomenon that mainly affects people with Parkinson's disease, but it can also be caused by other neurological diseases.
This disorder manifests as a sudden inability to move, causing a feeling of “blockage” while walking.
Understanding the causes, types, and available treatment options is critical to better manage these episodes and improve the quality of life of those affected.
Symptoms of gear freezing
Freezing is mainly manifested by a sudden inability to start or continue movement while walking. This phenomenon can last from a few seconds to several minutes and can occur in a variety of situations, such as in narrow passages such as a doorway, or walking among many people, or when the floor has different colors.
Some patients describe it as a reduction in stride length to a shuffling of the feet (a phenomenon called “festination”), or as an alternating tremor of the legs. Others describe a feeling of motor blockage, as if the feet are “stuck to the floor” while the upper body continues to move.
According to a study by Zhang and colleagues (2021), more than half of Parkinson's Disease patients suffer from freezing of walking.
Freezing episodes are an important contributor to increased fall risk in affected persons, with about 70% of patients reporting at least one fall per year (Wood et al, 2002).
Causes of the gear freezing
The causes of this phenomenon are still being studied, but it appears that alterations in the brain circuits that control movement play a crucial role. In particular, fluctuations in levels of dopamine, a neurotransmitter essential for motor control, may influence the occurrence of these episodes.
In a 2019 study at the Laboratory for Movement Analysis in Würzburg (Pozzi, et al.), the activity of the motor cerebral cortex and subthalamic nucleus was recorded before, during, and after the onset of freezing. The results found that during these episodes patients show a functional loss of connectivity between these two brain regions, as if they temporarily stop communicating.
This suggests that gear freezing may result from a communication deficit between different brain areas (circuitopathy) and not just dopamine deficiency.
Freezing can also be triggered by various factors, cognitive and emotional situations and environments such as approaching a narrow passage or doorway, dual-tasking, or the presence of many distractions. Anxiety and cognitive decline, often comorbidities of Parkinson's disease, can exacerbate freezing of walking, making it more difficult to control movement.
Types of gear freezing
This symptom can occur in several forms, each with specific characteristics.
- The freezing start occurs when the person attempts to start walking from a stationary position but fails to do so.
- The freezing while walking occurs while the person is already in motion, often coinciding with changes in direction or steps through doorways, and can cause falls with serious consequences.
- Finally, there is the freezing in specific situations, which occurs in special settings such as crowded environments or during stressful situations.
Understanding these types is critical to developing effective management and treatment strategies.
Treatment options
Treatment of gear freezing is multidisciplinary and may include a combination of medication, physiotherapy, occupational therapy and, in some cases, surgery.
- I dopaminergic drugs, such as levodopa, can help manage symptoms, although effectiveness may vary from person to person, but they are not known to provide relief to the problem of freezing.
- La physiotherapy, through specific exercise programs, can improve coordination and muscle strength, reducing the severity of freezing episodes.
- In some cases, the deep brain stimulation (DBS) can be considered to improve symptoms; however, the benefits of this invasive intervention are limited over time, as reflected in several scientific literature articles.
AMPS Gondola Therapy.
An effective therapeutic option for the treatment of walking freezing is Gondola AMPS (Automated Mechanical Peripheral Stimulation) therapy. This treatment, delivered by a CE-certified medical device, consists of mechanical stimulation of two specific points on both feet, through which a pulse is sent to the brain that helps increase functional connectivity in brain areas involved in movement by improving gait, balance, and fluidity of movement, thereby also reducing episodes of freezing.
Clinical studies have shown that Gondola AMPS therapy can decrease episodes of walking freezing, improving patients' quality of life. Documented benefits include improved walking speed, stride length, and decreased gait variability, as well as improved body rotation during movement.
The therapy is noninvasive, can be easily integrated into the daily routine, and is a very useful treatment option for people with this disorder.
Therapeutic challenges and potential future treatments
Gait freezing is one of the most debilitating symptoms of Parkinson's disease, especially in the advanced stages of the disease. According to the authors of a review published in Parkinsonism and Related Disorders, current pharmacological and surgical treatments are only partially effective for many patients.
The complexity of the pathophysiology of freezing, involving a multiplicity of neuronal circuits and cognitive deficits, makes it difficult to tailor pharmacological interventions to the specific needs of each patient.
A multidisciplinary approach, combining pharmacological and nonpharmacological treatments, is considered the best option because it combines the benefits of all treatments taken to reduce the symptoms of the disease.
Gondola AMPS therapy can be a valuable addition to existing therapies, improving the overall effectiveness of treatment. Supplementing Gondola AMPS with traditional pharmacological and rehabilitative therapies can allow treatment to be tailored to each patient's specific needs, while also providing greater stability during walking and more effective management of walking freezing.
Tips for preventing and coping with freezing episodes
Freezing gait poses a significant challenge for many people with Parkinson's disease, but with a thorough understanding of the symptoms, causes, and available treatment options, quality of life can be improved.
Through a combination of medical treatment, physical therapy and practical strategies, patients can find effective ways to manage this condition and maintain their independence.
Maintaining good posture and wearing appropriate shoes can reduce the risk of new episodes.
When a freezing episode occurs, it is important to keep calm and try to restore the rhythm of walking by stopping and starting again with the first step a little longer than usual.
Gondola AMPS therapy offers an effective new option, and effectively integrates with traditional therapies and providing a noninvasive option to improve movement management.
References
- Perez-Lloret S, Negre-Pages L, Damier P, et al. Prevalence, determinants, and effect on quality of life of freezing of gait in Parkinson disease. JAMA Neurol. 2014;71(7):884-890. doi:10.1001/jamaneurol.2014.753
- Wood BH, Bilclough JA, Bowron A, Walker RW. Incidence and prediction of falls in Parkinson's disease: a prospective multidisciplinary study. J Neurol Neurosurg Psychiatry. 2002;72(6):721-725. doi:10.1136/jnnp.72.6.721
- Zhang WS, et al. Prevalence of freezing of gait in Parkinson's disease: a systematic review and meta-analysis [published correction appears in J Neurol. 2021 Aug 24;:]. J Neurol. 2021;268(11):4138-4150. doi:10.1007/s00415-021-10685-5
- Pozzi NG, Canessa A, Palmisano C, et al. Freezing of gait in Parkinson's disease reflects a sudden derangement of locomotor network dynamics. Brain. 2019;142(7):2037-2050. doi:10.1093/brain/awz141
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