Gait and balance disorders in patients with atypical parkinsonian syndromes

• Published in: Revue neurologique Vol. 166; no. 2; pp. 188 - 195
• Main Authors: Welter, M-L, Westby, G W M, Chastan, N
• Format: Journal Article
• Language: French
• Published: France 01.02.2010
• Subjects: Disease Progression; Gait Disorders, Neurologic - etiology; Gait Disorders, Neurologic - physiopathology; Gravitation; Humans; Lewy Body Disease - etiology; Lewy Body Disease - physiopathology; Multiple System Atrophy - etiology; Multiple System Atrophy - physiopathology; Nerve Degeneration - etiology; Nerve Degeneration - physiopathology; Parkinsonian Disorders - complications; Parkinsonian Disorders - physiopathology; Postural Balance - physiology; Sensation Disorders - etiology; Sensation Disorders - physiopathology; Supranuclear Palsy, Progressive - etiology; Supranuclear Palsy, Progressive - physiopathology; Walking - physiology
• ISSN: 0035-3787
• DOI: 10.1016/j.neurol.2009.05.016

The degenerative Parkinsonian "Plus" syndromes form a heterogeneous spectrum of pathologies comprising multiple system atrophy, progressive supranuclear palsy, Lewy body disease and cortico-basal degeneration. Their developmental profile is distinguished from that of Parkinson's disease by the early appearance of gait and balance disorders, isolated freezing of gait, primary progressive freezing of gait or an isolated or "pure" akinesia. The origin of these symptoms however remains poorly understood. The association of nigrostriatal dopamine neuron loss with either cortical lesions, in the case of cortico-basal degeneration and Lewy body disease, and/or of the brainstem, in the case of progressive supranuclear palsy, explains both the severity of the motor symptoms and the lack of, or minimal, improvement following levodopa therapy. Other symptomatic drug and surgical treatments have been proposed, but with generally disappointing results. Physiotherapeutic techniques targeting balance control can bring some temporary improvements.