Medication For Freezing Of Gait In Patients With Parkinson Disease

Background:Freezing of gait(FOG)is a common symptom in patients with advanced Parkinson’s disease(PD) representing a major cause of disability and falls.Its mechanism involved in dopamine,abnormal gait parameters,cognitve dysfunction and so on. And there are limited treatment options for FOG both at home and abroad.Treatment studies of Selegiline and Amantadine have shown limited benefit for FOG.Objective:To evaluate the efficacy of amantadine and selegiline on FOG in patients with Parkinson Disease.And to compare the curative effect between them.At last,we hope to find a simple method to clinical evaluation of FOG.Methods: We recruite patients with FOG of the Neurology Clinic and department of the First Affiliated Hospital of Dalian Medical University From March 2014-March2015.And all of the patients conform to the following conditions :1)all were diagnosed with idiopathic Parkinson’s Disease using the UK Parkinson Disease Brain Bank Criteria;2)at least 2 years of course, no treatment or only treated with levodopa;3)both FOGQ and UPDRS show that there is FOG;4)all patients with FOG can improve gait by laser pen guidance. The follwing exclusion criteria were applied:1)Other Parkinson’s disease,for example secondary Parkinson’s syndrome(drugs, toxic, infection, traumatic,vascular, etc.), Parkinson plus syndrome, essential tremor, other diseases cause symptoms of Parkinson’s patients, 2)the patients treated with dopamine agonists;3)patients with “On”period freezing gait;4) Those who can’t complete history physical examination and scale inspectors, nervous system; 5) severe mental behavior or heart,cerebrovascular disease, 6) severe medical disease, such as heart, lung, liver, kidney disease;7) not signed informed consent.We recorded the patient’s gender,age,Hoehn-Yahr stage,the Unified Parkinson’s Disease Rating Scale,Schwab &England daily activities classification score, FOGQ, MMSE, MOCA,HAMA and HAMD.Patients were divided into 2 groups named A and B. Amantadine was assigned to group A,and selegiline to group B.We completed UPDRS-III, FOGQ, MMSE,MOCA, HAMA and HAMD evaluation at 4 weeks and 12 weeks.And all of them finished self-report of the medicinal cure effect(i.e. Improved or not improved).We used SPSS 13.0 for date analysis.And one sample t-test was used for comparison before and after medication.Two-sample t-test for independent samples andchi-squaer test were applied to compare the two groups.Result:Group A showed that the patients treated with selegiline can improve the FOG phenomenon,and can not only reduce the FOGQ and UPDRS-III score but also HAMA,HAMD,MOCA score.Group B showed that amantadine can aslo improve the FOG phenomenon,but can only reduce the FOGQ,HAMA,HAMD score.Comparing the two groups,we found there is no difference of the effect of the two drugs in the shaort time.And maybe the FOGQ is more sensitive for evaluating the improvement of FOG.Conclusion:1.Both selegiline and amantadine can improve the freezing of gait Parkinson’s patients2. The short term curative effect of selegiline and amanatadine is the same3. FOGQ is simple and effective methodwas to evaluate the PD with FOG.