festinations

Festinations are a gait disturbance characterized by rapid, small, shuffling steps that occur with a forward-leaning posture. The steps tend to be progressively shorter and more frequent, causing the individual to appear to hurry forward and sometimes propel into a forward fall. Festination is most commonly seen in parkinsonian syndromes, where it can occur with or without an accompanying freezing of gait.

Etiology and pathophysiology

Festination is primarily associated with disorders affecting the basal ganglia and dopaminergic circuits, especially idiopathic Parkinson's disease and other parkinsonian syndromes such as multiple system atrophy and progressive supranuclear palsy. It reflects impaired gait automaticity and postural reflexes, and may emerge as a progression from freezing of gait or other movement abnormalities. Less commonly, festination may occur in severe organic or vascular dementia or other conditions that disrupt motor planning and balance.

Clinical features

Typical features include rapid, small steps, a stooped or forward-leaning trunk, and a tendency to speed up as walking continues. Patients may have difficulty initiating walking or turning, and festination can be accompanied by episodes of freezing. The gait is more pronounced when attempting to maintain a straight path and may increase the risk of forward falls.

Diagnosis

Diagnosis is clinical and based on observation of gait patterns and associated parkinsonian signs. There is no specific diagnostic test for festination itself; assessment of the underlying condition (eg, Parkinson's disease) guides management. Gait analysis and neuroimaging may help support a diagnosis of an extrapyramidal syndrome.

Management and prognosis

Management focuses on treating the underlying disorder and mitigating symptoms. Optimizing dopaminergic therapy may reduce festination in some patients with Parkinson's disease. Physical therapy, balance and gait training, and cueing strategies (such as rhythmic auditory cues or visual floor markers) can help regulate step length and timing. Assistive devices and, in selected cases, neuromodulation therapies (eg, deep brain stimulation) may be considered. Festination generally indicates advancing parkinsonian motor impairment and an increased risk of falls, warranting ongoing monitoring and falls-prevention measures.