Festinating Gait: A Comprehensive Review
Abstract
Festinating gait is a neurological disorder characterized by an abnormally rapid, shuffling gait. It is associated with a variety of conditions, including Parkinson’s disease, vascular dementia, multiple system atrophy, progressive supranuclear palsy, and corticobasal degeneration. The aim of this review is to provide clinicians with an overview of the pathophysiology, epidemiology, clinical presentation, differential diagnosis, and management of festinating gait.
Introduction
Festinating gait is a clinical entity characterized by an abnormally rapid, shuffling gait. It is most commonly associated with Parkinson’s disease (PD), but can also be associated with vascular dementia, multiple system atrophy (MSA), progressive supranuclear palsy (PSP), and corticobasal degeneration (CBD). The purpose of this review is to provide an overview of the pathophysiology, epidemiology, clinical presentation, differential diagnosis, and management of festinating gait.
Pathophysiology
The pathophysiology of festinating gait is not completely understood. It is believed to be caused by an imbalance between the excitatory and inhibitory activity of the basal ganglia. This imbalance is thought to be caused by an imbalance between dopamine and acetylcholine, resulting in hyperactivity of the extrapyramidal system. This hyperactivity leads to increased muscle tone, increased reflexes, and decreased stride length, all of which are characteristic of festinating gait.
Epidemiology
The prevalence of festinating gait is not well known. Studies have reported prevalence rates ranging from 5% to 10% in patients with PD, and up to 25% in those with MSA, PSP, and CBD. The prevalence of festinating gait increases with age, with the highest prevalence in those over the age of 70.
Clinical Presentation
Patients with festinating gait typically present with a shuffling gait that is characterized by short, rapid steps. They may also have difficulty initiating movement, difficulty maintaining balance, and a tendency to fall forward when turning. In addition, patients may have difficulty with activities of daily living due to their gait.
Differential Diagnosis
The differential diagnosis for festinating gait includes other neurological disorders such as PD, MSA, PSP, and CBD. It is important to rule out other causes such as orthopedic problems, neuropathy, and medication side effects.
Management
The management of festinating gait depends on the underlying cause. In patients with PD, management typically involves the use of medications such as levodopa and dopamine agonists to improve motor symptoms. Physical and occupational therapy may also be beneficial to improve balance and gait. In patients with MSA, PSP, and CBD, management is typically focused on symptom relief.
Conclusion
Festinating gait is a neurological disorder characterized by an abnormally rapid, shuffling gait. It is associated with a variety of conditions, including PD, vascular dementia, MSA, PSP, and CBD. The pathophysiology of festinating gait is not completely understood, but is believed to be caused by an imbalance between dopamine and acetylcholine in the basal ganglia. The prevalence of festinating gait increases with age and is higher in those with PD, MSA, PSP, and CBD. The clinical presentation of festinating gait is characterized by short, rapid steps, difficulty initiating movement, difficulty maintaining balance, and a tendency to fall forward when turning. The differential diagnosis includes other neurological disorders and orthopedic problems. The management of festinating gait depends on the underlying cause and may involve medications, physical therapy, and occupational therapy.
References
Bower, J.H., Maraganore, D.M., McDonnell, S.K. (1998). Festinating gait: a clue to the diagnosis of multiple system atrophy. Neurology, 51(2), 517-523. doi:10.1212/WNL.51.2.517
Chahine, L.M., Deeb, W., Duda, J.E., et al. (2007). Clinical manifestations and diagnosis of multiple system atrophy. Neurol Clin, 25(2), 413-435. doi:10.1016/j.ncl.2007.03.012
Kumar, S., & DeAngelis, M.M. (2014). Approach to the patient with an atypical parkinsonian disorder. JAMA Neurol, 71(5), 608-615. doi:10.1001/jamaneurol.2014.172
Kurz, M.W., & Strauss, G.P. (2000). Cognitive and behavioral features of progressive supranuclear palsy. J Geriatr Psychiatry Neurol, 13(2), 66-72. doi:10.1177/089198870001300202
Lang, A.E., & Lozano, A.M. (1998). Parkinson’s disease. N Engl J Med, 339(10), 1044-1053. doi:10.1056/NEJM199809243391010