From the Guidelines
Parkinson's-like walking is primarily caused by neurodegenerative diseases, with the most common cause being Parkinson's disease (PD), followed by progressive supranuclear palsy (PSP), multiple system atrophy (MSA), and corticobasal degeneration (CBD) 1. The clinical presentation of these diseases is characterized by motor symptoms of tremor, rigidity, postural instability, and bradykinesia.
- Parkinson's disease is a synucleinopathy with neuronal deposits of Lewy bodies, and its clinical presentation is characterized by resting tremor, bradykinesia, and rigidity 1.
- PSP, MSA, and CBD are considered atypical Parkinsonisms and demonstrate the classic findings of PD, including bradykinesia and rigidity, with additional clinical features 1. Some key features of these diseases include:
- Autonomic dysfunction, behavioral changes, and dementia in PD 1
- Cerebellar ataxia, pyramidal signs, and dysautonomia in MSA 1
- Asymmetric limb clumsiness, unilateral limb rigidity, and dystonia in CBD 1
- Lurching gait, axial dystonia, and ocular symptoms in PSP 1 Correctly diagnosing a Parkinsonian syndrome on clinical features alone can be quite challenging, and imaging remains an essential diagnostic tool in the evaluation of a patient presenting with Parkinsonian symptoms 1.
From the Research
Causes of Parkinson's-like Walking
- Parkinson's-like walking, also known as parkinsonian gait, can be caused by various conditions, including secondary parkinsonism 2, normal pressure hydrocephalus (NPH) 3, 4, and vascular parkinsonism 2, 5.
- Secondary parkinsonism is a group of disorders that can cause parkinsonian symptoms, including drug-induced parkinsonism (DIP) and idiopathic normal pressure hydrocephalus (iNPH) 2, 6.
- NPH is a condition characterized by an accumulation of cerebrospinal fluid in the brain, leading to increased pressure and damage to brain tissue 3, 4.
- Vascular parkinsonism is a condition caused by damage to the brain's blood vessels, leading to parkinsonian symptoms 2, 5.
Characteristics of Parkinson's-like Walking
- Parkinson's-like walking is characterized by a distinctive gait disturbance, including a slow and shuffling gait, difficulty with balance and posture, and a tendency to freeze or hesitate while walking 2, 5.
- The gait disturbance in parkinsonian syndromes can be an important clue to the underlying diagnosis and can help differentiate between different conditions 5.
- The assessment of gait and postural impairment is essential for initiating appropriate treatment strategies and for documenting the outcome of interventions 5.
Treatment of Parkinson's-like Walking
- Treatment of parkinson's-like walking depends on the underlying cause of the condition 2, 6, 4.
- DIP and iNPH are considered reversible and treatable forms of parkinsonism, and early diagnosis and treatment intervention are crucial for improving symptoms 2, 6.
- In cases of iNPH associated with parkinsonism, patients may benefit from ventriculoperitoneal (VP) shunt insertion plus dopamine oral therapy 4.