Freezing of gait (FOG) is a common gait disturbance phenomenon in multiple system atrophy (MSA) patients.
Autonomic Symptoms
All people with MSA have autonomic dysfunction, but it varies in severity from person to person. Symptoms can include: Cold hands or feet and heat intolerance, because control of body temperature is impaired.
Freezing of gait (FoG) is an often dramatic, episodic gait pattern that is common in advanced Parkinson's disease (PD), other parkinsonian syndromes, and microvascular ischaemic lesions.
During the final stages of the disease, patients have trouble chewing, swallowing, speaking and breathing.
People typically live about 7 to 10 years after multiple system atrophy symptoms first appear. However, the survival rate with MSA varies widely. Death is often due to respiratory problems, infections or blood clots in the lungs (pulmonary embolus).
The disease tends to progress rapidly. About one half of people with MSA-P have lost most of their motor skills within 5 years of onset of the disease.
Freezing of gait (FOG) is frequently considered as one of the dopamine-resistant motor symptoms of Parkinsonism. Recent studies have clearly demonstrated that the Off-related FOG is improved by levodopa (L-dopa) or entacapone treatment. L-dopa can decrease duration of each FOG episode as well as its frequency.
There are options for treating freezing of gait, including adjusting your PD medications, using tools like sensory cueing, and using a walking aid. If freezing of gait is an issue for you or a loved one, be sure to speak to your neurologist and physical therapist about it.
Festination is a tendency to speed up in parallel with a loss of normal amplitude of repetitive movement (petit pas, micrographia and inaudible speech). Freezing is a breakdown of repetitive voluntary movement emerging through festination or suddenly.
A person with MSA has much slower movements than normal (bradykinesia). This can make it difficult to carry out everyday tasks. Movement is hard to initiate, and the person will often have a distinctive slow, shuffling walk with very small steps. Some people may also have stiff and tense muscles.
An additional manifestation of MSA is sudden death, in which patients die of no apparent reason 24 h after the onset of symptoms [9]. Sudden death in MSA usually occurs during sleep [10] and may occur at an early disease stage [11].
RFC1-related ataxia is a mimic of early multiple system atrophy | Journal of Neurology, Neurosurgery & Psychiatry.
Sleep disorders in patients with MSA include rapid eye movement sleep behavior disorder (RBD), excessive daytime sleepiness (EDS), and nocturnal sleep disturbances. Previous studies showed that 69% to 100% of patients with MSA experience RBD.
Malnutrition is associated with higher mortality in the elderly population19 and MSA patients are frequently associated with weight loss20 and a malnutritional state8.
THE FREEZING of gait is defined as a sudden and transient break (motor block) in the walking motion. Patients describe their feet as being "glued" or "magnetized" to the floor. Initiating or executing movement and switching motor tasks appear to be inhibited, or a break appears in continuous motion.
Akinesia is a disease symptom that causes a person to lose the ability to move their muscles on their own. Sometimes a person's body feels as if it is “frozen” in time. Doctors commonly associate akinesia with Parkinson's disease, which causes someone to lose control of their movements.
You're most likely to freeze when you're walking, as walking is a series of individual movements that happen in a particular order. If one part of the sequence is interrupted, the whole movement can come to a stop. Freezing is common when: you're walking towards doorways, chairs or around obstacles.
Freezing of gait (FOG) is common in Parkinson disease (PD). FOG refers to sudden, relatively brief episodes of gait arrest, experienced subjectively by patients as their feet being “glued to the floor.”1 The relationship between FOG and dopaminergic medication is complex.
The progression of MSA varies, but the condition does not go into remission. As the disorder progresses, daily activities become more difficult. Possible complications include: Breathing problems during sleep.
MSA affects men and women equally, with an average age of onset of approximately 55 years [2, 3].
In this unselected referral autopsy series of patients with antemortem diagnoses of MSA, the diagnostic accuracy was about 62%, which is within the range of other autopsy series.