Die Geschichte des ‚Freezing-of-gait‘ beim Parkinson-Syndrom – vom Phänomen zum Symptom

Zusammenfassung

In der Übersichtsarbeit wird der Hintergrund des Phänomens Freezing-of-Gait (FOG) beim Parkinson-Syndrom beleuchtet. Die Charakterisierung des Phänomens als Symptom und die unterschiedlich definierten Subtypen werden diskutiert. Dabei stellen die unterschiedlichen Ausprägungsformen eine erhebliche Herausforderung an die alltägliche Behandlung und auch an die einheitliche Diagnostik bei klinischen Studien dar. Die bisherigen, standardisierten Erfassungsmethoden mittels Fragebögen und semistandardisierten klinischen Untersuchungen werden in Relevanz zur patientenspezifischen Versorgung dargestellt. Bei den derzeitigen Therapieformen spielen neben der Optimierung der dopaminergen Medikation gezielte medikamentöse Optionen bislang keine wesentliche Rolle, was aber auch an der Trennschärfe der standardisierten Diagnostik liegen kann. Dadurch ist beim variantenreichen Phänomen FOG auch die Evidenzlage der Tiefen Hirnstimulation eingeschränkt. Im Alltag können hingegen Physiotherapie und Cueing-Strategien sehr gute Erfolge erzielen, auch wenn die Studienlage bzgl. höchster Evidenzklasse eher gering ist. Die Entwicklungen der Technologie scheinen sowohl die diagnostische Trennschärfe als auch das individualisierte „Cueing“-Angebot zu revolutionieren. Aber auch hier fehlen noch ausreichend große Studien, die diese Diagnostik- und Therapieformen hinterlegen. Trotzdem ist davon auszugehen, dass vielen Patienten diese „neuen Tools“ gerne nutzen werden und der Behandlungsalltag für Arzt und Physiotherapeuten entsprechend belebt wird.

Abstract

The background of the freezing-of-gait (FOG) phenomenon in Parkinson’s syndrome is presented in this review. The following issues are addressed: characterization of the symptom freezing and its subtypes that challenge standardized diagnostic procedures; available assessment methods generating freezing-related parameters that not only support clinical studies but can also be applied in everyday care, and current therapy options. FOG exists in different subtypes, and clinical and diagnostic definitions are limited by subjective characterization and semi-standardized tests. FOG-specific drug options are not existing, apart from the optimization of dopaminergic medication, which may also be due to the poor discriminatory power of standardized diagnostics. This is also true for deep brain stimulation. Both of these therapeutic options may be due not only to the complex neural network alterations as a motor-control correlate of FOG, but also because of challenging diagnostic assessments methodologies. Innovative, wearable, sensor-based diagnostic strategies are currently being developed, and supportive therapies using tools and technologies focusing on ‘cueing’ are becoming increasingly well accepted. Even though high level evidence is missing, they provide a helpful treatment option for individualized therapy. It can be assumed that these options will become particularly popular due to technological progress and likely alter the everyday treatment challenges faced by doctors and therapists.

Schlüsselwörter

Freezing-of-gait Questionnaire - Cueing - Sensor-basierte Ganganalyse

Key words

Freezing-of-gait Questionnaire - Cueing - Sensor-based gait analysis

Publication History

Received: 11 March 2020

Accepted: 22 July 2020

Article published online:
21 September 2020

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