Diagnose und Therapie von Festination und Freezing

Zusammenfassung

Motorische Blockaden während des Gehens sind als eine episodisch auftretende Störung der Ganginitiierung und des Lokomotionserhalts bei Parkinsonsyndromen und zentralen Gangstörungen definiert. Phänomenologisch werden Festination, trembling-in-place und total akinesia als Freezing-Formen unterschieden. Fünf differente Gangsituationen wurden als klassische Provokatoren für Freezing-Episoden benannt. Um eine Testung durch einen Beobachter klinisch einfach und aussagekräftig durchführen zu können, haben wir ein neues Testinstrument, den Freezing-ofgait-Score (FOG-Score) entwickelt, der im klinischen Alltag erprobt wird. Freezing bei Parkinsonpatienten ist meist dopasensitiv, kann aber auch im On-Zustand des Patienten auftreten und ist dann schwer zu therapieren.Wir diskutieren standardisierte Therapieschemata für Patienten mit On-Freezing, die wir an unserem Zentrum entwickelt haben.

Summary

Motor blocks during walking are defined as sudden episodic inabilities to initiate or sustain locomotion in Parkinson’s disease (PD) or other higher-level gait disorders. Phenomenologically festination is differentiated from trembling-in-place and from total akinesia. Five situations have been described as classical provoking environments. In order to clinically assess freezing with short-term time intervals we have developed a new scoring instrument that is currently further validated. Freezing is dopa-sensitive in most PD patients, however, it can occur during On-medication states, and then is difficult to treat. We report on physiotherapeutical approaches to overcome and reduce On-freezing by standarized treatment approaches.

Schlüsselwörter

Parkinson - Akinese - Festination - Freezing

Keywords

Parkinson’s disease - akinesia - festination - freezing

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