EpistemisFestinating march
Specialty: Neurology.
Why it occurs
- Advanced idiopathic Parkinson's disease
- Pharmacological parkinsonism induced by typical or atypical neuroleptics
- Progressive Supranuclear Palsy (PSP) or Multiple System Atrophy (MSA)
- Normal pressure hydrocephalus (Hakim-Adams syndrome, although apaxic gait predominates)
- Diffuse small vessel disease (subcortical vascular parkinsonism with pacing)
Initial workup
Evaluation of gait observing the posture in flexion, bradykinesia, reduction of bilateral arm swing and the phenomenon of festination (progressively shorter and faster steps leaning the trunk forward to avoid falling); Brain MRI to quantify subcortical vascular lesions, midbrain atrophy (hummingbird sign in PSP), or disproportionate ventricular dilation; DaTscan if there is diagnostic doubt with essential tremor.
red flags
Rapid onset festinating gait with severe freezing of gait that causes frequent falls on the back without defense reflexes, or severe rigidity associated with severe dysphagia that exposes the patient to imminent risk of pneumonia due to aspiration.
Standard management
- Levodopa/Carbidopa — 250/25 mg, progressively adjusting according to motor response and gastrointestinal tolerance
- Rotigotine transdermal patch — 2-8 mg/24h
- Rasagiline — 1 mg/day, MAO-B inhibitor
- Adjustment or suspension of dopaminergic blockers if the cause is pharmacological.
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Neurology
- Listed causes
- 5
- Treatment options
- 4