ArticleNPJ Parkinson's disease2023
Exploring the levodopa-paradox of freezing of gait in dopaminergic medication-naïve Parkinson's disease populations.
Article in NPJ Parkinson's disease, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 2 of them syntheses that pooled it.
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Who cites it
16 citing papers in PubMed, 2 syntheses or guidelines pooled it, 15 citations in OpenAlex.
- Deep brain stimulation for freezing of gait in Parkinson's disease: An updated systematic review, meta-analysis, and a single-center clinical experience.Neurosurgical review · 2026Pooled it
- Botulinum Toxin Effects on Freezing of Gait in Parkinson's Disease: A Systematic Review.Toxins · 2024Pooled it
- Complex Exercises Improve Cognition in People With Parkinson's Disease and Freezing of Gait.Neurorehabilitation and neural repair · 2025Trial
- Towards the Prevention of Freezing of Gait in Parkinson's Disease.The European journal of neuroscience · 2026Review
- Feasibility of Real-Time Autonomous Functional Electrical Stimulation for Freezing of Gait.The European journal of neuroscience · 2026Article
- Neurotransmitter Systems Underlying Freezing of Gait (FOG) in Parkinson's Disease.The European journal of neuroscience · 2026Review
- Is levodopa induced freezing of gait a paradox or an expected phenomenon?: a clinico-pathophysiological hypothesis.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2026Review
- Use of AR/VR for Treatment of Freezing of Gait (FoG) in Parkinson's Disease (PD).Journal of clinical medicine · 2026Review
- Development and validation of a clinical prediction model for first fall in early Parkinson's disease: a study of two fall-naive cohorts.Frontiers in aging neuroscience · 2026Article
- Identifying gait characteristics associated with freezing of gait in Parkinson's disease: An analysis of on and off medication states.Gait & posture · 2025Article
- The Progression of NUS1-Associated Parkinson's Disease and the Diagnostic Potential of Plasma NgBR.CNS neuroscience & therapeutics · 2025Article
- Digital gait biomarkers in Parkinson's disease: susceptibility/risk, progression, response to exercise, and prognosis.NPJ Parkinson's disease · 2025Review
- Predicting Freezing of Gait in Parkinson's Disease: A Machine-Learning-Based Approach in ON and OFF Medication States.Journal of clinical medicine · 2025Article
- Evaluation of mobility parameters in individuals with Parkinson's disease with and without freezing of gait.Arquivos de neuro-psiquiatria · 2025Article
- Case report: Levodopa challenge test is important in identifying dopamine-induced freezing of gait in patient with Parkinson's disease.Frontiers in human neuroscience · 2024Article
- A meta-analysis identifies factors predicting the future development of freezing of gait in Parkinson's disease.NPJ Parkinson's disease · 2023Review
Corrections and comments
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Authors and funding
7 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
The relationship between dopaminergic treatment and freezing of gait (FOG) in Parkinson's disease (PD) is complex: levodopa is the most effective symptomatic treatment for FOG, but long-term pulsatile levodopa treatment has also been linked to an increase in the occurrence of FOG. This concept, however, continues to be debated. Here, we compared the occurrence of FOG between a levodopa-naive PD cohort and a levodopa-treated cohort. Forty-nine treatment-naive patients and 150 levodopa-treated patients were included. The time since first motor symptoms was at least 5 years. Disease severity was assessed using the MDS-UPDRS part III. Occurrence of FOG was assessed subjectively (new freezing-of-gait-questionnaire) and objectively (rapid turns test and Timed Up-and-Go test). The presence of FOG was compared between the levodopa-treated and levodopa-naive groups using a chi-square test of homogeneity. We also performed a binomial Firth logistic regression with disease duration, disease severity, country of inclusion, location of measurement, and executive function as covariates. Subjective FOG was more common in the levodopa-treated cohort (n = 41, 27%) compared to the levodopa-naive cohort (n = 2, 4%, p < 0.001). The association between FOG and levodopa treatment remained after adjustment for covariates (OR = 6.04, 95%Cl [1.60, 33.44], p = 0.006). Objectively verified FOG was more common in the levodopa-treated cohort (n = 21, 14%) compared to the levodopa-naive cohort (n = 1, 2%, p = 0.02). We found an association between long-term pulsatile levodopa treatment and an increased occurrence of FOG. Future studies should further explore the role of nonphysiological stimulation of dopamine receptors in generating FOG, as a basis for possible prevention studies.
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Registered trials
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