Treatment of gait ignition failure with ropinirole

Gait ignition failure (GIF) is a syndrome characterized by hesitation or inability to initiate gait from a static position. It may occur in a variety of conditions, including normal pressure hydrocephalus, subcortical vascular disease, parkinsonian syndromes and a variety of focal lesions. Previous information on the treatment of GIF has been primarily anecdotal, but there have been a few reports of response to dopamine agonists. We report a 63-year-old man with anoxic encephalopathy who developed GIF nine years after the initial anoxic insult. The patient's GIF responded robustly, albeit transiently, to ropinirole. MRI was unrevealing, but a positron emission tomography scan showed hypometabolism in the deep frontal ACA/MCA watershed area; this may have disconnected the basal ganglia from the motor cortex and/or interrupted dopaminergic mesocortical transmission. Our understanding of the pathophysiology and the treatment of GIF remains limited, but there may be at least a limited therapeutic role for dopamine agonists.