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“On‐State” Freezing of Gait: Insights and Treatment With Levodopa Intestinal Gel Infusion

Freezing of gait (FOG) is characterized by sudden and brief episodes of inability to produce effective stepping and is a major risk factor for falls in Parkinson’s disease (PD). FOG in PD can rarely occur paradoxically in the “on state” in a dose-dependent manner; however, treatment of this levodopainduced complication is limited. We report on a patient with on-state FOG that responded to L-dopa/carbidopa intestinal gel (LCIG) infusion in a dose-dependent manner, providing new insights into FOG and L-dopa responsiveness. A 61-year-old female diagnosed with typical PD for 8 years developed recurrent falls secondary to FOG over 12 months. She was taking levodopa-carbidopa CR 200/50 mg five times per day, pramipexole ER 1.5 mg/day, and rasagiline 1 mg/day. During a practically defined off (12 hours without medications), she had a narrow-based gait with reduced step height and stride length, but there was no FOG (Video 1). An oral L-dopa