Diagnosis and treatment of Parkinson's freezing gait, expert consensus point!

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Diagnosis and treatment of Parkinson's freezing gait, expert consensus point!

2021-11-26 06:07:50 11 ℃

Mid-evening Parkinson's disease (PD) often appears unstable posture (PIGD), where the posture instability is mainly manifested as the tilting of torso, the spinal deformation and the body stability are abnormal; the gait is often including panic step, frozen steps (FOG) and other forms of expression, such as the step change, the step length is reduced, the walking rhythm changes, and the dual task performs dysfunction. In order to improve the level of FOG, give full play to the advantages of drugs, non-drug therapy and their combined therapy, and better guide our clinical practice of my country, combined with experts clinical experience, after repeated discussion, repeated condensed "Parkinson's freezing step Mixed Medical diagnosis and treatment expert consensus (2021) ".

Frozen step

2010 Washington SAR Seminar will define the FOG as "short-term, suddenly suspended or significantly reduced during attempting, and suddenly stop or significantly reduced". Common layers are as follows:

(1) According to the dopamine reactive classification

Dopamine reaction type: The main freezing is mainly due to the loss of dopaminergic neurons of the central nervous system, which is better for dopamine drugs. The most common;

Dopamine induction: The freezing is related to drug-induced, and dopaminergic drug treatment is poor;

Dopamine resistance: The opening period will have a freeze-standing process during the period, caused by non-dicamine brain tissue damage, and non-dopaminergic drug treatment may be effective.

(2) Depending on clinical characteristics

Originally trembled: overcome walking blocks, there is a bilateral leg (knee) alternately trembled;

Small pace is trampolilized;

Complete exercise can not be moved: limbs and torso cannot move, this is relatively rare, but the most known.

Frozen step diagnosis and evaluation

(1) Diagnosis

The diagnosis of FOG in Parkinson's disease currently has no unified diagnostic criteria, mainly based on its clinical features:

The feet or toe do not leave the ground or just wipe the ground;

The double-sided calf is alternately trembled, the frequency is 3 ~ 8Hz;

FOG speed is accelerated or the walking rhythm is increased, and the step size is reduced;

The subjective feeling is "sticky" on the floor during freezing.

Visual obstacles occur during walking process, or changes in front of the surface, or in the narrow or crowded area, it will be induced by suddenly pushing or scared in the walking process;

FOG can always be alleviated by a number of tips;

FOG can be asymmetrical, mainly affecting a foot, or more easily when turned in a certain direction.

(2) Assessment

PIGD scale: Assessment content is a stable and gait for step / stability obstacles to determine the type, the evaluation method is strict;

MINI-BESTEST: MINI-BESTEST: It is mainly for the evaluation of gait and posture stability;

Dynamic gait index and functional gait evaluation: Verify the measurement of the evaluation step dynamic balance;

Frozen step questionnaire (FOG-Q): Effective and quantify the monitoring tool description of frozen and gait barriers;

6min Walk Test and 10M Walk Test: Simple and time consuming for walking speed;

Functional precision test: Terminal stability detection is fast and simple;

Timing - walk test: Evaluation of standing, walking, steering stability is a representative tool for evaluating PD;

After pulling test, Pt): UPDRS-posture stability evaluation is an important indicator, but the inspectors have a certain impact on the results;

Auxiliary Delivery Device Assessment Parameters: Auxiliary Delivery Device You can record the posture step motion parameters of FOG patients objectively data from electronic sensors. Through the analysis of computer software, the patient's FOG is characterized, predicting the risk of patients.

Frozen treatment

(1) Drug treatment

Recommended comments: Requantilan can be used as an adjuvant treatment of FOG (A2 evidence). PD patients who were receiving STN deep brain stimulus (DBS) but still had a PD patients attempts 1 mg • Kg-1 • D-1 copepin methyl aphenomethane (A2 evidence). Le Zhuo Pakist is the preferred drug (B-class evidence) for the treatment of Parkinson's disease. Luo Shigatium pastel treatment can significantly improve FOG (B-level evidence). SSRIS (paroxetine or Essei) or SnRis significantly improved FOG (B-level evidence). Garlandimen therapy effectively improves FOG (B-level evidence), and Fuxciba Garna Kabeng has proven to effectively improve FOG (B-level evidence), but whether it is useful to improve FOG evidence is inconsistent (C Level evidence). LCIG, Si Lilan, Iracea-Legali-therapy FOG effective (C-grade evidence); dopamine receptor agonist increases the risk of FOG (D-class evidence), doctors in a PD patient with FOG prescription dopamine receptor agonist Be cautious. No improvement in the acetylolate esterase inhibitors (A2 evidence) after treatment (A2 evidence), lack of strong evidence, indicating that oral diamondine can improve FOG (C-Class Evidence).

(2) Surgical treatment

Recommendations: STN-DBS improved reactive dopamine and dopamine induced the FOG (C level recommended), pedunculopontine nucleus (PPN) -DBS different conclusions (C level recommended); globus pallidus inner portion (GPI) -DBS still further Study; the steroids (STN) -dbs have no improvement in dopamine resistance FOG (recommended by C level).

(3) Physical therapy and rehabilitation

Recommended comments: RTMS improves dopamine reactive type and dopamine-inducible FOG (Class C recommended), spinal cord stimulating (SCS) is effective in effectiveness of each type of FOG effectively needs to explore; auxiliary wearable equipment improves dopamine reactive and dopamine-inducible FOG (BLevel recommendation), poppermine resistance FOG may be effective (Class C recommended); rehabilitation treatment improves dopamine reaction type and dopamine-inducible FOG (D-level recommendation), which may be effective (D-level recommendation).Medical vessels are sorted out: Cao Xuebing, Tang Bei Sha, Liu Zhenguo. Parkinson's Frozen Supported Countries Consensus (2021) [J]. Stroke and Neurological Disease, 2021,28 (05): 599-604.