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Hi, My name is Stewart Factor.
I'm a Clinical Movement
Disorder Neurologist
at Emory University.
I will be presenting Part 2 of
the clinical presentation
of Parkinson's disease.
I'm going to start this
part by talking about
the episodic gait disorders
associated with
Parkinson's disease.
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The first one I'll
discuss is festination.
The term festination comes from
the Latin festinare which
means to hasten or to hurry,
and the definition in relation
to Parkinson's disease
is the development of
rapid small steps leading
to running in an attempt
to keep the center of
gravity between the feet while
the trunk is pitched
forward involuntarily.
An unintended and
progressive increase
in the cadence and a
decrease in step length
while walking which may be
associated with the
trunk leaning forward,
and this is part
of the definition
that was brought out
in the last year in
the freezing of gait
workshop in Jerusalem.
The frequency of festination
is about 30% after
eight years of disease
and about a third of patients
who have festination
are falling repeatedly.
The response of festination
to levodopa is partial,
and only about 20% of patients
will have a good
response to the drug.
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Festination can have
two phenotypes.
This has been well described by
Jorik Nonnekes in a paper
in 2019 describing one
associated with abnormal
locomotion and the other
associated with abnormal
postural stability.
The locomotive version begins
at the initiation of gait with
very small steps followed
by a sequence of
events that ultimately
lead to freezing of gait,
which is another
episodic gait disorder.
This sequence of events
sometimes called
the sequence effect is
where the steps get
shorter and shorter,
and ultimately, the gait stops
and they are frozen
to the floor.
In the postural defect form,
the patients begin
leaning forward,
so their balance is already off
and they try to make
balance-correcting steps.
But the steps are very small
and they're leaning
very forward,
and because of the poor balance,
they ultimately end up falling.
The locomotive version
ends with freezing and
the postural instability form
ultimately ends in falling.
