Freezing of Gait: A Therapeutic Perspective

Despite improved definition of the problem and better understanding of its phenomenology, freezing of gait (FoG) remains a therapeutic enigma for clinicians and neuroscientists alike. Patients with Parkinson disease (PD) or other neurological disorders experiencing FoG are similarly frustrated, despite the benefits that levodopa and other medications provide for control of PD's primary motor features. For those burdened by episodes of FoG, current therapeutic options are quite limited. Some patients achieve improvements from pharmacotherapy-for example, by adjunctive use of an oral dopaminergic agonist or by subcutaneous infusion of apomorphine. If needed, deep brain stimulation sometimes offers symptomatic improvements. Certain interventions devised by physical therapists (or discovered by patients themselves) can improve FoG. However, successful pharmacotherapy for FoG has lagged behind, though the future holds some promising leads for therapies acting on dopaminergic, adenosinergic, noradrenergic, glutamatergic, and cholinergic circuitry.