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Comparative analysis of the gait disorder of normal pressure hydrocephalus and Parkinson's disease

2001; BMJ; Volume: 70; Issue: 3 Linguagem: Inglês

10.1136/jnnp.70.3.289

1468-330X

Henning Stolze,

Cerebral Palsy and Movement Disorders

OBJECTIVES Comparative gait analyses in neurological diseases interfering with locomotion are of particular interest, as many hypokinetic gait disorders have the same main features. The aim of the present study was (1) to compare the gait disturbance in normal pressure hydrocephalus and Parkinson9s disease; (2) to evaluate which variables of the disturbed gait pattern respond to specific treatment in both diseases; and (3) to assess the responsiveness to visual and acoustic cues for gait improvement. METHODS In study 1 gait analysis was carried out on 11 patients with normal pressure hydrocephalus, 10 patients with Parkinson9s disease, and 12 age matched healthy control subjects, on a walkway and on a treadmill. In study 2, patients with normal pressure hydrocephalus were reinvestigated after removal of 30 ml CSF, and patients with Parkinson9s disease after administration of 150 mg levodopa. In part 3 visual cues were provided as stripes fixed on the walkway and acoustic cues as beats of a metronome. RESULTS The gait disorder in both diseases shared the feature of a reduced gait velocity, due to a diminished and highly variable stride length. Specific features of the gait disturbance in normal pressure hydrocephalus were a broad based gait pattern with outward rotated feet and a diminished height of the steps. After treatment in both diseases, the speed increased, due to an enlarged stride length, now presenting a lower variability. All other gait variables remained unaffected. External cues only mildly improved gait in normal pressure hydrocephalus, whereas they were highly effective in raising the stride length and cadence in Parkinson9s disease. CONCLUSION The gait pattern in normal pressure hydrocephalus is clearly distinguishable from the gait of Parkinson9s disease. As well as the basal ganglia output connections, other pathways and structures most likely in the frontal lobes are responsible for the gait pattern and especially the disturbed dynamic equilibrium in normal pressure hydrocephalus. Hypokinesia and its responsiveness to external cues in both diseases are assumed to be an expression of a disturbed motor planning.