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Postural instability, freezing gait, and difficulty in speech and swallowing are some of the most commonly witnessed symptoms in an individual diagnosed with Parkinson's disease.
Currently approved and marketed in Japan for the treatment of symptomatic orthostatic hypotension, freezing gait in Parkinson's disease and intradialytic hypotension, Droxidopa has accumulated over 15 years of proven safety and efficacy, historically generating annual revenues of approximately $50 million in Japan.
Individuals with Parkinson's disease with a more severe, freezing gait pattern relied more heavily on attention to walk than those without this pattern and even more so from aged-matched controls (6).
The most distressing symptom was off time, followed by freezing gait, postural instability, sleep disturbance, and difficulty concentrating.
As the disease progresses, individuals experience additional symptoms such as freezing gait, difficulty swallowing, drooling, and voice softening.
The most severe motor symptoms reported, in order of greatest severity, were tremor/dyskinesia, writing, changing positions, walking outside home, fatigue, muscle ache, freezing gait, and muscle cramps.
In regard to research question 1, the most distressing symptom, on average, was "off time" (when movement is greatly impaired or absent), followed (in order) by freezing gait, postural instability, sleep disturbance, and difficulty concentrating, all four of which had similar mean distress scores.
The symptoms with greatest intensity, in order of intensity, were sleep disturbance, off time, freezing gait, and bilateral hand tremor.
Symptom frequency and duration were positively and significantly related to symptom distress for symptoms of freezing gait, postural instability, swallowing, dyskinesia, and unilateral hand tremor.
Four of the five most distressing symptoms were ones that are generally experienced by individuals in the moderately advanced and advanced stages of disease--off time, freezing gait, sleep disturbance, and difficulty concentrating.
Freezing gait also increases the risk for falls [1-2,5,9].
People with akinesia who demonstrate kinesia paradoxa are observed to walk with visual cue patterns, such as over obstacles in their path or up stairs, with significantly reduced shuffling and freezing gait [2,7,9-10,19-20].