Freezing of Gait with Parkinson's Disease - I.V. Ozone and I.V. Glutathione

Freezing of Gait. Common in patients with Parkinson's disease. 

Causes a disturbance in the ability to walk. It is described as sudden and transient in nature and can be severely debilitating for patients. 

 The most common cause of freezing of gait (FOG) is Parkinson disease, but both lesion-induced FOG and PD-related FOG “cause an episodic disorder of human locomotion, characterized by sudden and brief episodes of the inability to produce effective forward stepping.” Freezing of gait is often medication resistant. Parkinson's related FOG is heterogeneous and composed of various sub types. Of these sub types the most similar to lesion induced FOG is likely the ‘resistant’ or ‘unresponsive’ sub type. In this sub type, FOG fails to respond to L-dopa, which is similar to patients with lesion-induced FOG.  Nueroimaging studies in Parkinson's patients suffering from FOG have identified many structural and functional abnormalities across a variety of brain regions. Implicated regions include components of the motor and premotor networks, executive-attention network, right-sided visuospatial network, caudate nucleus, and locomotor centers in the brainstem. Lesions to multiple different brain areas can cause FOG, but those areas are part of a common functional network.  Specifically, lesion locations resulting in FOG are functionally connected to a focal area in the dorsal medial cerebellum.Ideally, we would contrast our FOG lesions with lesions causing a different gait phenotype such as gait ataxia or higher-level gait disorder (HLGD). Unfortunately, there is significant phenotypic overlap between FOG and these conditions.

 If you are living with Parkinson's disease, the gut is where I begin treatment. We remove all gluten, most grains and dairy out of the diet. Processed carbohydrates aggravate SIBO and don't allow leaky gut mucosa to heal properly. High-protein foods block the absorption of the main Parkinson's medications - Levadopa or L-dopa which affects their efficacy. I also test for Herpes 6 and elevated heavy metals with an eye on mercury. The golden triangle in Parkinson's is poor gut function, high viral loads, previous exposure to pesticides and elevated mercury.

Because of poor gut function I strongly recommend I.V. therapies. Ozone chelation and I.V. glutathione both improve function while we are healing the gut with L-glutamine, fish oils, NAC, turmeric, probiotics, gelatin, phosphatidyl choline and resveratrol.

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1. Which of the following statements is/are TRUE regarding freezing-of-gait (FOG)?

A. Parkinson disease (PD) is the most common cause of this condition
B. Both lesion-induced FOG and PD-related FOG involves sudden episodes of impaired forward stepping ability
C. FOG typically responds well to pharmacologic treatment
D. A and B

2. True or False. Unlike most forms of PD-related FOG, lesion-induced FOG is generally responsive to L-dopa.

A. True
B. False

3. Which of the following brain regions may be involved in PD-related FOG?

A. Brain stem locomotor centers
B. Caudate nucleus
C. Right-sided visuospatial network
D. Any of the above

 4. True or False. Lesion locations resulting in FOG are functionally connected to a focal area in the dorsal medial cerebellum.

A. True
B. False

 5. True or False. Lesion-induced FOG has phenotypic overlap with gait ataxia.

A. True
B. False

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Answer Key:

1. A and B

2. B. False

3. D. Any of the Above

4. A. True

5. A. True

For complete information, see:

Fasano A, Laganiere SE, Lam S, Fox MD. Lesions causing freezing of gait localize to a cerebellar functional network. [Published online ahead of print January 24, 2017]. Ann Neurol. 2017;81:129–141. Accessed February 22, 2017.