Freezing in Parkinson’s: Treatments for FOG & Medication Adjustments

The experience is often described as if your feet are glued to the floor, a sudden and unsettling inability to initiate or continue movement. This phenomenon, known as freezing of gait (FOG), is a common and frustrating symptom for many individuals with Parkinson’s disease, particularly as the condition progresses. While there’s no single cure, understanding the potential causes, triggers, and emerging treatments can empower patients and their care teams to navigate these challenging episodes more effectively.

Understanding Freezing in Parkinson’s

Freezing isn’t simply a lack of strength. it’s a disruption in the brain’s ability to send signals for movement. It can affect not only walking but also turning, rising from a chair, or even speech. Up to 80 percent of people with advanced Parkinson’s experience FOG, and the unpredictability of these episodes can lead to anxiety and an increased risk of falls. A 2021 research review found that over half of those with Parkinson’s (51% of 9,072 participants) experience freezing of gait, with prevalence increasing from around 38% in early stages to 65% in advanced stages.

Episodes can be brief – less than a second – or last for more than 30 seconds. Sometimes, individuals will attempt to walk, but their feet remain stationary while their upper body continues to move forward, increasing the risk of losing balance. The underlying cause isn’t fully understood, but it’s believed to involve issues with communication between brain regions responsible for movement planning and execution.

The Role of Dopamine and Medication

Often, the first line of defense against freezing episodes involves a careful review of medication. “Medication adjustments are often the first step, since freezing can be linked to low dopamine levels or medications wearing off,” explains Ejaz Shamim, MD, a neurologist at Kaiser Permanente. Parkinson’s disease is characterized by a loss of dopamine-producing cells in the brain, and fluctuations in dopamine levels can significantly impact movement. Increasing the dosage of medications like carbidopa-levodopa (Sinemet), which help boost dopamine production, is a common initial strategy.

However, even with optimized dopamine medication, freezing can persist. In these cases, healthcare providers may explore other options, such as amantadine (Symmetrel), droxidopa (Northera), or stimulants like atomoxetine (Strattera).

Rapid Relief with Apomorphine

For more immediate relief, apomorphine (Kynmobi) offers a fast-acting solution. This medication helps the body utilize dopamine more effectively and is available as an injection or a dissolving film placed under the tongue. While effective, apomorphine can cause side effects like dry mouth and irritation, which may limit its long-term use.

Deep Brain Stimulation: A Promising Avenue

Deep brain stimulation (DBS) is an FDA-approved treatment for Parkinson’s disease that involves surgically implanting a device to regulate electrical signals in the brain. Researchers are increasingly investigating its potential to alleviate freezing of gait, with promising early results. DBS doesn’t cure Parkinson’s, but it can help manage motor symptoms, including freezing, by modulating the brain circuits involved in movement.

Beyond Medication: Strategies for Management

While medication and DBS are essential tools, managing freezing often requires a multi-faceted approach. Successful management requires close coordination between movement specialists and medical providers managing Parkinson’s disease medications, including optimizing dopamine replacement therapy timing and adjusting medication schedules to minimize “off” time.

Individuals can also employ several strategies to mitigate freezing episodes. These include consciously shifting weight, stepping to a beat (music can be particularly helpful), and using visual cues – such as lines on the floor or a laser pointer – to provide a target for stepping. These techniques aim to “trick” the brain into initiating movement by providing external stimuli.

The Future of Freezing Research

The search for more effective treatments for freezing in Parkinson’s is ongoing. Researchers are currently exploring innovative approaches like brain training exercises and wearable technology designed to detect and potentially interrupt freezing episodes before they fully develop. These techniques are still in the research phase, but they hold the potential to significantly improve the quality of life for individuals living with Parkinson’s disease. According to Liao, many of these techniques are expected to turn into available to a wider patient population in the near future.

What to expect moving forward: Ongoing studies will continue to refine our understanding of the underlying mechanisms of freezing and evaluate the efficacy of novel interventions. As research progresses, it’s likely that treatment strategies will become increasingly personalized, tailored to the specific needs and characteristics of each individual with Parkinson’s disease. Regular communication with a neurologist and a multidisciplinary care team is crucial for optimizing treatment and adapting to the evolving landscape of Parkinson’s care.