Les troubles de la marche sont un des symptômes moteurs les plus invalidants de la maladie de Parkinson. Ils apparaissent dès le début de la maladie, sous forme d’une hypokinésie de la marche, d’abord réversible sous L-dopa puis viennent se greffer au fil des années des troubles intermittents (freezing de la marche) à la physiopathologie complexe, responsables de chutes et de perte d’autonomie. Nous aborderons leur physiopathologie, puis les différentes approches thérapeutiques disponibles pour leur prise en charge : physiothérapie, traitements médicamenteux, traitements chirurgicaux.

Gait disorders are among the most disabling symptoms in Parkinson's disease. In the early stages, gait slows and step length shortens, compared with age-matched healthy adults. However, reduced amplitude of arm swing, smoothness of locomotion and increased interlimb asymmetry are more specific to Parkinson's disease and are often the first motor symptoms. After a few years, many of the spatiotemporal features altered in the early stages progress bilaterally, so that asymmetryis less obvious. Movement becomes more bradykinetic with disease progression. Postural changes, such as stooped posture (camptocormia), might further contribute to the decline in gait by altering gait kinematics. Motor automaticity becomes further impaired, resulting in fragmented motor function, such as defragmentation of turn around and problems with gait initiation. Freezing of gait and festination might appear resulting in an increased risk of falling in this stage. At the advanced stage, motor blocks become more frequent, accompanied by reduced balance and postural control provoking severe risk of falling. Quantifying multiple gait features enhances sensitivity of gait quantification. Studies of neural connectivity and structural network topology have provided information on the mechanisms of gait impairment. We will review gait disorders’ pathophysiology, and several therapeutically approaches currently available: physiotherapy, pharmacological and surgical treatments.