American Board of Internal Medicine (ABIM) Certification Practice Exam

What is a key factor in initiating therapy for Parkinson's patients who experience freezing gait?

1. Frequent dosage interruptions

2. Immediate initiation of levodopa therapy

3. Referral for physical therapy

4. Starting with anticholinergics

The correct answer is: Immediate initiation of levodopa therapy

In Parkinson's disease, freezing gait is a common and challenging symptom that can significantly impact a patient's mobility and quality of life. The immediate initiation of levodopa therapy is a key factor in managing this symptom effectively. Levodopa is a precursor to dopamine, which is deficient in Parkinson's patients due to the degeneration of dopaminergic neurons. When levodopa is administered, it leads to improved dopamine levels in the brain, which can help alleviate motor symptoms, including rigidity, bradykinesia, and freezing gait. Prompt treatment with levodopa can lead to a rapid improvement in motor functions, making it crucial for patients experiencing debilitating symptoms like freezing gait. While physical therapy and other interventions may also contribute to the management of freezing gait, they can be more effective when a patient is on appropriate medication to address the underlying dopamine deficiency. Therefore, starting levodopa therapy takes precedence in the management strategy for these patients, emphasizing the importance of addressing the neurochemical basis of their symptoms right away.