Acknowledgement
We would like to acknowledge the use of information taken from the Parkinson’s Disease Society fact sheet Freezing in Parkinson’s in compiling this information.
Our thanks to Dr W Farid Abdo1for his help in reviewing this article.
The most important factor in treating freezing is to establish whether or not it responds to standard Parkinson’s medications. Freezing that occurs during ‘off ’ periods, when other symptoms such as stiffness, tremor and slowness return, often responds well to adjustments in the timing and dosage of medications, as this should prevent ‘wearing off ’ periods.
People who do experience freezing when they are ‘off’ must recognise that freezing and ‘off’ periods are separate phenomena requiring different management.
Freezing that is not related to ‘off’’ periods and occurs during ‘on ’ periods does not generally respond well to standard Parkinson’s medications or adjustments to timings or dosage. For those who take small doses of levodopa during the day, there may be an improvement if larger but less frequent doses are taken, although this may not be effective for everyone.
Caution! It is important to discuss any changes in medication with your doctor before making any adjustments.
Research carried out on the drug selegeline (Eldepry® and Zelapar® ) suggested that people who take it may be less likely to develop freezing problems, but there is no evidence that selegeline can be used to as a treatment.
Deep brain stimulation (DBS) can be effective in treating some Parkinson’s symptoms and can help with some, but not all, freezing episodes.
Clear adult freezing patterns do not manifest themselves until we are around 3 years old.
There are a lot of things you can do to help yourself but there are also experienced professionals who can offer very useful advice. Depending on the country in which you live your doctor may be your first contact and they may refer you to another expert. Alternatively, you might be able to book an appointment direct, although you may have to pay for this yourself.
In some countries there may be Parkinson’s Disease Nurse Specialists or nurses who specialise in neurology who can help as they will have considerable experience in dealing with freezing.
You may be referred to a physiotherapist or an occupational therapist. Which therapist you are referred to will depend on the country you live in, the resources available, and your individual needs, so it is hard to generalise but the following broadly outline the help you may receive:
Where symptoms can reappear unexpectedly and quickly, which some people describe as being like a light turning on and off.
The ‘on ’ period is when the drugs are working and there is good symptom control.
The ‘off ’ period is when the drugs are not working and the Parkinson's symptoms return.
This appears to be caused by an interaction between Parkinson's disease itself and the drug treatment.
See rigidity
Rhythmic shaking of part of the body. It is one of the main symptoms of Parkinson's disease, although it is not experienced by everyone.
Bradykinesia describes the slow execution of movement and impaired ability to adjust the body's position.
The word bradykinesia is derived from the Greek roots: bradys(slow) and kinesis(movement).
Term used to describe the gradual return of symptoms that occurs at the end of a dose of levodopa. This pattern appears when a person with Parkinson's disease has been using levodopa for many years.
The main type of drug prescribed to treat Parkinson's disease and has been in use since the late 1960s. The aim is to increase the levels of dopamine in the brain. Dopamine cannot be directly replaced because it cannot cross the blood-brain barrier that prevents potentially harmful substances in the blood from entering the brain. Levodopa is a chemical compound that can cross this barrier and is then converted into dopamine.
See also Types of medication available.
A treatment option for people with advanced Parkinson's disease. It uses one or two surgically implanted medical devices called neurostimulators, similar to cardiac pacemakers, to deliver electrical stimulation to precisely targeted areas on each side of the brain. This is commonly called deep brain stimulation. Stimulation of these areas appears to block the signals that cause the disabling motor symptoms of Parkinson's. As a result, many patients achieve greater control over their body movements.
See section on Deep Brain Stimulation [DBS].
Health profession that treats people of all ages who have physical problems that occur as a result of injury, illness or ageing. Methods they use include exercise, heat treatments, manipulation and hydrotherapy.
See section on Physiotherapy.
Health profession that helps people of all ages who are disabled, ill or aged to remain independent and lead fulfilling lives at home, in work and through leisure pursuits. The methods they use include specific activities and equipment.
See section on Occupational Therapy.
The care and treatment of the feet (also called chiropody).
A podiatrist (or chiropodist) deals with the assessment, diagnosis and treatment of the lower limb.
From the latin festino, meaning to hasten, festination is an involuntary shortening of stride and quickening of steps as if hurrying forward to keep balance. This appears as shuffling and hesitant steps when walking.
The process of providing cues, prompts, hints, and other meaningful information, direction, or instruction to aid a person who is experiencing difficulties.
See also Coping Strategies.
