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Gangstörungen in der Neurologie

Gait disturbances in neurology

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Zusammenfassung

Gangstörungen führen zu einem Verlust der Mobilität und damit der Autonomie. Stürze sind häufig die Folge und führen zu weiterer Immobilität. Der größte Risikofaktor für Gangstörungen ist das Alter. Daneben spielen Pharmaka, kognitive Störungen und ein Alkoholabusus eine große Rolle. Beim „gesunden“ Altern findet man lediglich eine geringe, kontinuierlich Abnahme der Gehgeschwindigkeit. Klassifiziert werden Gangstörungen in solche unterer Ebene (periphere Ursachen), mittlerer Ebene (spinale, zerebelläre, Basalganglienstörungen) und höchster Ebene (frontale Gangstörung, psychogene Gangstörung). Diese Einteilung ist jedoch nicht unumstritten. Besonders häufig sind Gangstörungen bei neurologischen Erkrankungen. Besonderheiten im Gangmuster bei hypokinetischen Gangstörungen, dystonen Gangstörungen, Hemi- und Paraspastik, Ataxien, vestibulären, peripher neuromuskulären und psychogenen Störungen werden detailliert beschrieben. Neben einer Reduktion von Risikofaktoren spielen in der Therapie von Gangstörungen 1. eine Verbesserung des physischen Zustands (Physiotherapie, Ausdauersportarten), 2. die Verschreibung von adäquaten Hilfsmitteln und 3. eine Sturzprävention die wichtigste Rolle.

Abstract

Gait disorders lead to loss of mobility and therefore of an individual’s autonomy. The greatest risk factor for gait disorders is old age. Other important factors include drugs and their side effects, cognitive impairment, and alcohol abuse. In successful aging there is only a slight decline in gait velocity. The classification into lower- (peripheral), middle- (spinal, basal ganglia), and higher-level gait disorders (e.g. frontal or psychogenic) is still common but contradictory. Gait disorders in neurology are frequent. Detailed descriptions of gait patterns in hypokinetic gait disorders, dystonic, hemi-, and paraparetic gait, ataxia, vestibular, neuromuscular, and psychogenic gait are given. Besides reduction of risk factors, improving the physical state (physiotherapy, sports), descriptions of walking aids, and the prevention of falls are extraordinarily important for the therapy of gait disorders.

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Literatur

  1. Achiron A, Ziv I, Goren M et al. (1993) Primary progressive freezing gait. Mov Disord 8: 293–297

    Article  PubMed  CAS  Google Scholar 

  2. Adams RD, Victor M, Ropper AH (1997) Disorders of stance and gait. Vol 6. McGraw-Hill, New York Toronto

  3. Allert N, Volkmann J, Dotse S et al. (2001) Effects of bilateral pallidal or subthalamic stimulation on gait in advanced Parkinson’s disease. Mov Disord 16: 1076–1085

    Article  PubMed  CAS  Google Scholar 

  4. Atchison PR, Thompson PD, Frackowiak RS, Marsden CD (1993) The syndrome of gait ignition failure: a report of six cases. Mov Disord 8: 285–292

    Article  PubMed  CAS  Google Scholar 

  5. Bäzner H, Oster M, Henning O et al. (2001) Amantadine increases gait steadiness in frontal gait disorder due to subcortical vascular encephalopathy: a double-blind randomized placebo-controlled trial based on quantitative gait analysis. Cerebrovasc Dis 11: 235–244

    Article  Google Scholar 

  6. Baloh RW, Ying SH, Jacobson KM (2003) A longitudinal study of gait and balance dysfunction in normal older people. Arch Neurol 60: 835–839

    Article  PubMed  Google Scholar 

  7. Bazner H, Oster M, Daffertshofer M, Hennerici M (2000) Assessment of gait in subcortical vascular encephalopathy by computerized analysis: a cross-sectional and longitudinal study. J Neurol 247: 841–849

    Article  PubMed  CAS  Google Scholar 

  8. Blin O, Ferrandez AM, Pailhous J, Serratrice G (1991) Dopa-sensitive and dopa-resistant gait parameters in Parkinson’s disease. J Neurol Sci 103: 51–54

    Article  PubMed  CAS  Google Scholar 

  9. Bloem BR, Haan J, Lagaay AM et al. (1992) Investgation of gait in elderly subjects over 88 years of age. J Geriatr Psychiatry Neurol 5: 78–84

    PubMed  CAS  Google Scholar 

  10. Bloem BR, Gussekloo J, Lagaay AM et al. (2000) Idiopathic senile gait disorders are signs of subclinical disease. J Am Geriatr Soc 48: 1098–1101

    PubMed  CAS  Google Scholar 

  11. Bloem BR, Grimbergen YA, Cramer M et al. (2001) Prospective assessment of falls in Parkinson’s disease. J Neurol 248: 950–958

    Article  PubMed  CAS  Google Scholar 

  12. Bohannon R (1989) Correlation of lower limb strengths and other variables with standing performance in stroke patients. Physiother Can 41: 198–202

    Google Scholar 

  13. Brandt T, Daroff RB (1980) The multisensory physiological and pathological vertigo syndromes. Ann Neurol 7: 195–203

    Article  PubMed  CAS  Google Scholar 

  14. Camicioli R, Howieson D, Lehman S, Kaye J (1997) Talking while walking: the effect of a dual task in aging and Alzheimer’s disease. Neurology 48: 955–958

    PubMed  CAS  Google Scholar 

  15. Dietz V (2001) Gait disorder in spasticity and Parkinson’s disease. Adv Neurol 87: 143–154

    PubMed  CAS  Google Scholar 

  16. Dietz V, Colombo G, Jensen L, Baumgartner L (1995) Locomotor capacity of spinal cord in paraplegic patients. Ann Neurol 37: 574–582

    Article  PubMed  CAS  Google Scholar 

  17. Elble RJ, Hughes L, Higgins C (1992) The syndrome of senile gait. J Neurol 239: 71–75

    Article  PubMed  CAS  Google Scholar 

  18. Elble RJ, Thomas SS, Higgins C, Colliver J (1991) Stride-dependent changes in gait of older people. J Neurol 238: 1–5

    Article  PubMed  CAS  Google Scholar 

  19. Factor SA, Jennings DL, Molho ES, Marek KL (2002) The natural history of the syndrome of primary progressive freezing gait. Arch Neurol 59: 1778–1783

    Article  PubMed  Google Scholar 

  20. Ferrandez AM, Pailhous J, Durup M (1990) Slowness in elderly gait. Exp Aging Res 16: 79–89

    Article  PubMed  CAS  Google Scholar 

  21. Folstein MF, Folstein SE, McHugh PR (1975) „Mini-mental state“. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12: 189–198

    Article  PubMed  CAS  Google Scholar 

  22. Forsen L, Sogaard AJ, Sandvig S et al. (2004) Risk of hip fracture in protected and unprotected falls in nursing homes in Norway. Inj Prev 10: 16–20

    Article  PubMed  CAS  Google Scholar 

  23. Fung J, Stewart JE, Barbeau H (1990) The combined effects of clonidine and cyproheptadine with interactive training on the modulation of locomotion in spinal cord injured subjects. J Neurol Sci 100: 85–93

    Article  PubMed  CAS  Google Scholar 

  24. Grimbergen YA, Knol M, Bloem BR et al. (2005) Falling in Huntington’s disease. Mov Disord [Suppl 10] 20: S9

  25. Hennerici MG, Oster M, Cohen S et al. (1994) Are gait disturbances and white matter degeneration early indicators of vascular dementia? Dementia 5: 197–202

    Article  PubMed  CAS  Google Scholar 

  26. Hesse S, Werner C (2003) Partial body weight supported treadmill training for gait recovery following stroke. Adv Neurol 92: 423–428

    PubMed  Google Scholar 

  27. Imai H, Nakamura T, Kondo T, Narabayashi H (1993) Dopa-unresponsive pure akinesia or freezing. A condition within a wide spectrum of PSP? Adv Neurol 60: 622–625

    PubMed  CAS  Google Scholar 

  28. Krauss JK, Faist M, Schubert M et al. (2001) Evaluation of gait in normal pressure hydrocephalus before and after shunting. Adv Neurol 87: 301–310

    PubMed  CAS  Google Scholar 

  29. Larish DD, Martin PE, Mungiole M (1988) Characteristic patterns of gait in the healthy old. Ann N Y Acad Sci 515: 18–32

    Article  PubMed  CAS  Google Scholar 

  30. Lempert T, Brandt T, Dieterich M, Huppert D (1991) How to identify psychogenic disorders of stance and gait. A video study in 37 patients. J Neurol 238: 140–146

    Article  PubMed  CAS  Google Scholar 

  31. Lord SE, Halligan PW, Wade DT (1998) Visual gait analysis: the development of a clinical assessment and scale. Clin Rehabil 12: 107–119

    Article  PubMed  CAS  Google Scholar 

  32. Lundin-Olsson L, Nyberg L, Gustafson Y (1997) „Stops walking when talking“ as a predictor of falls in elderly people. Lancet 349: 617

    Article  PubMed  CAS  Google Scholar 

  33. Lundgren-Lindquist B, Aniansson A, Rundgren A (1983) Functional studies in 79 year olds (part III). Scand J Rehabil Med 15: 125–131

    PubMed  CAS  Google Scholar 

  34. Maurer C, Mergner T, Xie J et al. (2003) Effect of chronic bilateral subthalamic nucleus (STN) stimulation on postural control in Parkinson’s disease. Brain 126: 1146–1163

    Article  PubMed  CAS  Google Scholar 

  35. Murray MP, Sepic SB, Gardner GM, Downs WJ (1978) Walking patterns of men with parkinsonism. Am J Phys Med 57: 278–294

    PubMed  CAS  Google Scholar 

  36. Nutt JG, Marsden CD, Thompson PD (1993) Human walking and higher-level gait disorders, particularly in the elderly [see comments]. Neurology 43: 268–279

    PubMed  CAS  Google Scholar 

  37. Newman G, Dovenmuehle RH, Busse EW (1960) Alterations in neurologic status with age. J Am Geriatr Soc 8: 915–917

    Google Scholar 

  38. Palliyath S, Hallett M, Thomas SL, Lebiedowska MK (1998) Gait in patients with cerebellar ataxia. Mov Disord 13: 958–964

    Article  PubMed  CAS  Google Scholar 

  39. Petrén K (1900) Über den Zusammenhang zwischen anatomisch bedingter und funktioneller Gangstörung (besonders in Form von trepidanter Abasie) im Greisenalter. Arch Psychiat Nervenkr 33/34: 818–871/444–489

    Google Scholar 

  40. Remy-Neris O, Denys P, Barbeau H et al. (1998) Effects of intrathecal clonidine on spinal reflexes, locomotion and bladder function in paraplegic human subjects. Electroencephalogr Clin Neurophysiol 106: 17–IL4

    Article  Google Scholar 

  41. Robertson LT, Horak FB, Anderson VC et al. (2001) Assessments of axial motor control during deep brain stimulation in parkinsonian patients. Neurosurgery 48: 544–551; discussion 551–552

    Article  PubMed  CAS  Google Scholar 

  42. Sahyoun C, Floyer-Lea A, Johansen-Berg H, Matthews PM (2004) Towards an understanding of gait control: brain activation during the anticipation, preparation and execution of foot movements. Neuroimage 21: 568–575

    Article  PubMed  CAS  Google Scholar 

  43. Scheidtmann K, Fries W, Muller F, Koenig E (2001) Effect of levodopa in combination with physiotherapy on functional motor recovery after stroke: a prospective, randomised, double-blind study. Lancet 358: 787–790

    Article  PubMed  CAS  Google Scholar 

  44. Springer S, Giladi N, Peretz C et al. (2006) Dual-tasking effects on gait variability: the role of aging, falls, and executive function. Mov Disord 21: 950–957

    Article  PubMed  Google Scholar 

  45. Stolze H, Klebe S, Baecker C et al. (2005) The prevalence of gait disorders in hospitalized neurological patients. Mov Disord 20: 89–94

    Article  PubMed  Google Scholar 

  46. Stolze H, Klebe S, Petersen G et al. (2002) Typical features of cerebellar ataxic gait. J Neurol Neurosurg Psychiatry 73: 310–312

    Article  PubMed  CAS  Google Scholar 

  47. Stolze H, Klebe S, Poepping M et al. (2001) Effects of bilateral subthalamic nucleus stimulation on parkinsonian gait. Neurology 57: 144–146

    PubMed  CAS  Google Scholar 

  48. Stolze H, Kuhtz-Buschbeck JP, Drucke H et al. (2000) Gait analysis in idiopathic normal pressure hydrocephalus – which parameters respond to the CSF tap test? Clin Neurophysiol 111: 1678–1686

    Article  PubMed  CAS  Google Scholar 

  49. Stolze H, Kuhtz-Buschbeck JP, Drucke H et al. (2001) Comparative analysis of the gait disorder of normal pressure hydrocephalus and Parkinson’s disease. J Neurol Neurosurg Psychiatry 70: 289–297

    Article  PubMed  CAS  Google Scholar 

  50. Stolze H, Kuhtz-Buschbeck JP, Mondwurf C et al. (1997) Gait analysis during treadmill and overground locomotion in children and adults. Electroencephalogr Clin Neurophysiol 105: 490–497

    Article  PubMed  CAS  Google Scholar 

  51. Stolze H, Kuhtz-Buschbeck JP, Mondwurf C et al. (1998) Retest reliability of spatiotemporal gait parameters in children and adults. Gait Posture 7: 125–130

    Article  PubMed  Google Scholar 

  52. Stolze H, Petersen G, Raethjen J et al. (2001) The gait disorder of advanced essential tremor. Brain 124: 2278–2286

    Article  PubMed  CAS  Google Scholar 

  53. Sudarsky L (2001) Gait disorders: prevalence, morbidity, and etiology. Adv Neurol 87: 111–117

    PubMed  CAS  Google Scholar 

  54. Sudarsky L, Simon S (1987) Gait disorder in late-life hydrocephalus. Arch Neurol 44: 263–267

    PubMed  CAS  Google Scholar 

  55. Iersel MB van, Hoefsloot W, Munneke M et al. (2004) Systematic review of quantitative clinical gait analysis in patients with dementia. Z Gerontol Geriatr 37: 27–32

    Article  PubMed  Google Scholar 

  56. Verghese J, Lipton RB, Hall CB et al. (2002) Abnormality of gait as a predictor of non-Alzheimer’s dementia. N Engl J Med 347: 1761–1768

    Article  PubMed  Google Scholar 

  57. Vieregge P (1996) Idiopathische Gangstörung im Alter – Klinische Phänomenologie und quantitative Erfassung. Huber, Berlin Göttingen Toronto

  58. Vieregge P, Stolze H, Klein C, Heberlein I (1997) Gait quantitation in Parkinson’s disease–locomotor disability and correlation to clinical rating scales. J Neural Transm 104: 237–248

    Article  PubMed  CAS  Google Scholar 

  59. Whittle M (1991) Gait analysis. An introduction. Butterworth-Heinemann, Oxford

  60. Widder B (1985) A new device to decrease falls. Geriatr Nurs 6: 287–288

    Article  PubMed  CAS  Google Scholar 

  61. Wilson RS, Schneider JA, Beckett LA et al. (2002) Progression of gait disorder and rigidity and risk of death in older persons. Neurology 58: 1815–1819

    PubMed  CAS  Google Scholar 

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  1. Klinik für Neurologie, Diakonissenanstalt Flensburg, Knuthstraße 1, 24939, Flensburg, Deutschland

    H. Stolze

  2. Klinik für Neurologie, Klinikum Lippe-Lemgo, Lemgo, Deutschland

    P. Vieregge

  3. Klinik für Neurologie, UKSH Campus Kiel, Kiel, Deutschland

    G. Deuschl

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Stolze, H., Vieregge, P. & Deuschl, G. Gangstörungen in der Neurologie. Nervenarzt 79, 485–499 (2008). https://doi.org/10.1007/s00115-007-2406-x

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