Kick and rush
Paradoxical kinesia in Parkinson disease
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A 68-year-old enthusiastic soccer player with idiopathic Parkinson disease (PD) had unpredictable, immobilizing freezing of gait, which did not respond even to high doses of dopaminergic medication. By kicking a tennis ball attached to a rubber band, he could reliably overcome freezing (video on the Neurology® Web site at www.neurology.org.).
Paradoxical kinesia is an enigmatic feature observed in advanced stages of PD.1 A deficit to execute motor sequences can be overcome by external visual or auditory cues.2 Enhanced activation of the lateral premotor cortex during paradoxical gait might compensate for the impaired function of supplemental motor area (SMA) and pre-SMA in PD (figure).
Figure Images shot during an on-phase with unpredictable freezing of gait
(A) Even with assistance, the patient is unable to walk continuously. (B) By kicking a tennis ball attached to a rubber band (left white arrow), he can dramatically speed up his walking. White arrows indicate the covered distance after 5 seconds.
1. Glickstein M, Stein J. Paradoxical movement in Parkinson's disease. Trends Neurosci 1991;14:480–482.OpenUrlCrossRefPubMed
2. Okuma Y. Freezing of gait in Parkinson's disease. J Neurol 2006;253 suppl 7:VII27–VII32.OpenUrlCrossRefPubMed
Footnotes
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Disclosure: The authors report no disclosures.
Supplemental data at www.neurology.org
Disputes & Debates: Rapid online correspondence
- Kick and rush: Paradoxical kinesia in Parkinson disease
- Bradley J. Robottom, MD, University of Maryland School of Medicine, 22 South Greene St Rm N4W46, Baltimore, MD, 21230brobo001@umaryland.edu
- William J. Weiner, MD
Submitted December 14, 2008 - Reply from the authors
- Friedrich Asmus, Dystonia Genetics Unit, Hertie-Institute for Clinical Brain Research, Center of Neurology, Hoppe-Seyler Str. 3, 72076 Tübingen, Germanyfriedrich.asmus@dystonia-genetics.com
- Heiko Huber, Thomas Gasser and Ludger Schöls
Submitted December 14, 2008
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