Improvement of Freezing of Gait in Patients with Parkinson's Disease by Imagining Bicycling
A 74-year-old woman found it difficult to begin walking at the age of 64. Neurological findings at the age of 66 revealed parkinsonism, such as microphonia, cogwheel type rigidity, bradykinesia, and FOG. She gradually developed difficulty walking due to severe FOG and postural instability (fig. ; online suppl. video segment ). Although the administration of L-dopa/DCI (600 mg/day) and ropinirole (12 mg/day), and visual and auditory cues did not improve the severe FOG, she was able to walk without FOG after imagining bicycling (fig. ; online suppl. video segment ), and the gait interruptions improved when imagining and mimicking bicycling after gait initiation (online suppl. video segment ). Imagining taking a large step, climbing stairs, or stepping over regular horizontal lines did not improve severe FOG. Severe FOG in its normal condition without imagining bicycling and the improvement of the FOG after imagining bicycling were similar to the gaits shown in online supplementary video segments and after several visits. Routine blood examinations were normal. A brain MRI showed mild chronic ischemic changes in the deep white matter.