[Festination and freezing]

Abstract

Akinesia, the core symptom of parkinsonism, is a comprehensive term and a disorder characterized by poverty, slowness and also freezing of movement. Parkinson (1817) in his original essay pointed out the festinating gait. 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. Freezing of gait occurs either at the start (start hesitation), through festination of gait or suddenly when turning or going through the narrow doorway. Narabayashi and the present author reported the first 2 cases with pure akinesia or freezing symptom without rigidity or tremor and unresponsive to L-DOPA therapy as a new condition at the 14th annual meeting of this Society, 1973. Kinésie paradoxal was always accompanied by this type of akinesia. HVA level in the cerebrospinal fluid was not below normal. The author suggested that the main pathological structures of the condition are different from Parkinson's disease. L-threo-DOPS, a synthetic norepinephrine (NE) precursor, had a mild-to-moderate effect on some cases with freezing, and the NE hypothesis for freezing was proposed (Narabayashi). 35 cases with this condition have been known in our clinic to date. Slowly progressive supranuclear ophthalmoplegia appeared later in some patients, several of whom were clinically and two were pathologically diagnosed as progressive supranuclear palsy. The nosological position and responsible lesion sites of this condition are discussed.