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Functional gait disorders, clinical phenomenology, and classification

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Abstract

Background

Functional gait disorders (FGDs) are relatively common in patients presenting for evaluation of a functional movement disorder (FMD). The diagnosis and classification of FGDs is complex because patients may have a primary FGD or a FMD interfering with gait.

Methods

We performed a detailed evaluation of clinical information and video recordings of gait in patients diagnosed with FMDs.

Results

We studied a total of 153 patients with FMDs, 68% females, with a mean age at onset of 36.4 years. A primary FGD was observed in 39.2% of patients; among these patients, 13 (8.5%) had an isolated FGD (a gait disorder without other FMDs). FMDs presented in 34% of patients with otherwise normal gait. Tremor was the most common FMD appearing during gait, but dystonia was the most common FMD interfering with gait. Patients with FGD had a higher frequency of slow-hesitant gait, astasia-abasia, bouncing, wide-based gait and scissoring compared with patients with FMDs occurring during gait. Bouncing gait with knee buckling was more frequently observed in patients with isolated FGD (P = 0.017). Patients with FGDs had a trend for higher frequency of wheelchair dependency (P = 0.073) than those with FMDs interfering with gait.

Conclusions

Abnormal gait may be observed as a primary FGD or in patients with other FMDs appearing during gait; both conditions are common and may cause disability.

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Author information

Authors and Affiliations

  1. Parkinson’s Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA

    José Fidel Baizabal-Carvallo & Joseph Jankovic

  2. Department of Internal Medicine, University of Guanajuato, C.P. 37320, León, Guanajuato, Mexico

    José Fidel Baizabal-Carvallo

  3. Polytechnique Institute, Mexico City, Mexico

    Marlene Alonso-Juarez

Authors
  1. José Fidel Baizabal-Carvallo
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  2. Marlene Alonso-Juarez
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  3. Joseph Jankovic
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Contributions

Dr. Baizabal-Carvallo gathered the data, made the statistical analysis, conceptualized, and wrote the first draft of the manuscript. Dr. Alonso-Juarez evaluated the data and reviewed the manuscript. Dr. Jankovic gathered the data, conceptualized, and reviewed the manuscript.

Corresponding author

Correspondence to José Fidel Baizabal-Carvallo.

Ethics declarations

Patients provided signed written informed consent, approved by the Baylor College of Medicine Institutional Review Board for Human Research, providing permission for videotaping and publishing the case and video in a scientific journal.

Conflict of interest

The authors declare that they have no conflict of interest.

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Electronic supplementary material

ESM 1

(DOCX 14 kb)

Video 1

This is a 62-year-old man with severe astasia-abasia; he needs to hold on to the wall to walk. (AVI 93591 kb)

Video 2

This is a 66-year-old man with functional parkinsonism and very slow, hesitant gait. (AVI 91739 kb)

Video 3

This 20-year-old patient has bouncing gait with knee buckling, he uses a cane to stabilize his gait. (AVI 40870 kb)

Video 4

This is a 16-year old girl with left lower-limb fixed dystonia, she needs crutches to walk; after a correction maneuver the patient is able to walk normally. (AVI 76923 kb)

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Baizabal-Carvallo, J.F., Alonso-Juarez, M. & Jankovic, J. Functional gait disorders, clinical phenomenology, and classification. Neurol Sci 41, 911–915 (2020). https://doi.org/10.1007/s10072-019-04185-8

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  • DOI: https://doi.org/10.1007/s10072-019-04185-8

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