Treatment options for postural instability and gait difficulties in Parkinson's disease.

Treatment options for postural instability and gait difficulties in Parkinson's disease. Expert Rev Neurother. 2019 Aug 16;: Authors: Müller MLTM, Marusic U, van Emde Boas M, Weiss D, Bohnen NI Abstract Introduction: Gait and balance disorders in Parkinson's disease (PD) represent a major therapeutic challenge as frequent falls and freezing of gait impair quality of life and predict mortality. Limited dopaminergic therapy responses implicate non-dopaminergic mechanisms calling for alternative therapies. Areas covered: The authors provide a review that encompasses pathophysiological changes involved in axial motor impairments in PD, pharmacological approaches, exercise and physical therapy, improving physical activity levels, invasive and non-invasive neurostimulation, cueing interventions and wearable technology, and cognitive interventions. Expert opinion: There are many promising therapies available that, to a variable degree, affect gait and balance disorders in PD. However, not one therapy is the "silver bullet" that provides full relief and ultimately meaningfully improves the patient's quality of life. Sedentariness, apathy and emergence of frailty in advancing PD, especially in the setting of medical comorbidities, are perhaps the biggest threats to experience sustained benefits with any of the available therapeutic options and therefore need to be aggressively treated as early as possible. Multimodal or combination therapies may provide compleme...
Source: Expert Review of Neurotherapeutics - Category: Neurology Tags: Expert Rev Neurother Source Type: research