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      Freezing of gait: moving forward on a mysterious clinical phenomenon

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          Abstract

          Freezing of gait (FoG) is a unique and disabling clinical phenomenon characterised by brief episodes of inability to step or by extremely short steps that typically occur on initiating gait or on turning while walking. Patients with FoG, which is a feature of parkinsonian syndromes, show variability in gait metrics between FoG episodes and a substantial reduction in step length with frequent trembling of the legs during FoG episodes. Physiological, functional imaging, and clinical–pathological studies point to disturbances in frontal cortical regions, the basal ganglia, and the midbrain locomotor region as the probable origins of FoG. Medications, deep brain stimulation, and rehabilitation techniques can alleviate symptoms of FoG in some patients, but these treatments lack efficacy in patients with advanced FoG. A better understanding of the phenomenon is needed to aid the development of effective therapeutic strategies.

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          Author and article information

          Contributors
          Journal
          101139309
          30413
          Lancet Neurol
          Lancet Neurol
          The Lancet. Neurology
          1474-4422
          1474-4465
          23 May 2020
          August 2011
          13 June 2020
          : 10
          : 8
          : 734-744
          Affiliations
          Department of Neurology, Oregon Health & Science University, Portland, OR, USA
          Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands
          Tel-Aviv Sourasky Medical Centre, Sadder School of Medicine, Tel Aviv University,Tel Aviv, Israel
          National Institute of Neurologic Disorders and Stroke, Bethesda, MD, USA
          Department of Neurology, Oregon Health & Science University, Portland, OR, USA
          Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Tervuursevest, Belgium
          Author notes

          Contributors

          All authors contributed to the organisation of the meeting programme and the selection of invited speakers for the Freezing of gait: from clinical phenomena to basic mechanisms of gait and balance workshop. JGN obtained the funding for the meeting. All authors wrote specific sections of the report, which were subsequently synthesised into one draft by JGN. All authors reviewed and critiqued subsequent versions of the report.

          Freezing of gait workshop attendees

          Speakers—Q Almeida (Wilfrid Laurier University, Waterloo, ON, Canada); A Bastian (Johns Hopkins School of Medicine, Baltimore, MD, USA); B Bloem (Radboud University Medical Center, Nijmegen, Netherlands); B Day (Institute of Neurology, University College London, London, UK); N Giladi (Tel Aviv Sourasky Medical Center, Tel Aviv, Israel); S Grillner (Karolinska Institutet, Stockholm, Sweden); M Hallett (NINDS-NIH, Bethesda, MD, USA); J M HausdorfF (Tel Aviv Sourasky Medical Center, Tel Aviv, Israel); F Horak (Oregon Health & Science University, Portland, OR, USA); R Iansek (Kingston Centre Southern Health, Victoria, Australia); L Jordan (University of Manitoba Winnipeg, MB, Canada); R Lemon (Institute of Neurology, University College London, London, UK); S Lewis (University of Sydney, Sydney, Australia); J Masdeu (NINDS-NIH, Bethesda, MD, USA); M Morris (University of Melbourne, Melbourne, Victoria, Australia); A Nieuwboer (Katholieke Universiteit Leuven, Heverlee, Belgium); J Nutt (Oregon Health & Science University, Portland, OR, USA); M Plotnik (Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel); P Strick (School of Medicine, University of Pittsburgh, Pittsburg, PA, USA); K Takakusaki (Asahikawa Medical College, Asahikawa, Japan).

          Discussants—P Conteras (University of Maryland, Baltimore, MD, USA); D Corcos (University of Illinois, Chicago, IL, USA); J Duysens (Radboud University Nijmegen Medical Center, Nijmegen, Netherlands); S Factor (Emory University School of Medicine, Atlanta, GA, USA); S Fahn (Columbia University, New York, NY, USA); J Frank (University of Windsor, Windsor, ON, Canada); T Hanakawa (National Institute of Neuroscience, Tokyo, Japan); C MacKinnon (Northwestern University, Chicago, IL, USA); S Moore (Mount Sinai School of Medicine, New York, NY, USA); Y Okuma (Juntendo University Shizuoka Hospital, Shizuoka, Japan); M Rogers (University of Maryland School of Medicine, Baltimore, MD, USA); P Thompson (The Royal Adelaide Hospital, Adelaide, SA, Australia); S Wise (Olschefskie Institute for the Neurobiology of Knowledge, Washington DC, USA).

          Next generation—D Benninger (NINDS-NIH, Bethesda, MD, USA); R Cohen (Oregon Health & Science University, Portland, OR, USA); M Danoudis (University of Melbourne, Melbourne, Victoria, Australia); K Iseki (NINDS-NIH, Bethesda, MD, USA); J Jacobs (University of Vermont, Burlington, VT, USA); V Kelly (University of Washington, Seattle, WA, USA); I Meidan (Tel Aviv Sourasky Medical Center, Tel Aviv, Israel); A Mirelman (Tel Aviv Sourasky Medical Center, Tel Aviv, Israel); B Smith (Oregon Health & Science University, Portland, OR, USA); A Snijders (Radboud University, Nijmegen, Netherlands); J Spildooren (Katholieke Universiteit Leuven, Heverlee, Belgium); S Vercruysse (Katholieke Universiteit Leuven, Heverlee, Belgium).

          Sponsors—W Galpem (NINDS-NIH, Bethesda, MD, USA); W G Chen (NINDS-NIH, Bethesda, MD, USA); D Chen (NIA-NIH, Bethesda, MD, USA).

          Correspondence to: Dr John G Nutt, Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA nuttj@ 123456ohsu.edu
          Article
          PMC7293393 PMC7293393 7293393 nihpa1594563
          10.1016/S1474-4422(11)70143-0
          7293393
          21777828
          86fcc590-fa2d-455f-9498-bc11ac1540f3
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