Objective: We analyzed gait and postural instability in patients after methanol intoxication, with the aim to verify prevailing parkinsonian gait pattern.

Background: Methanol is a highly toxic substance, resembling ethanol in smell and taste. Besides acute symptoms, parkinsonism and gait disturbances were reported as late-term neurological sequelae after intoxication. 137 patients were intoxicated by methanol in the Czech Republic since 2012, during mass outbreak due to unintentional ingestion of adulterated spirits, mortality was high with 83 survivors.

Methods: 43 patients (9 females; mean age 46, range 24-73 years) were seen 2 to 8 months after proven acute methanol intoxication. Examination included the Natural History and Neuroprotection in Parkinson Plus Syndromes – Parkinson Plus Scale (NNIPPS-PPS), the shortened version of Falls Efficacy Scale-International (FES-I), Pull-test, and Timed Up and Go test (TUG). Gait cycle was evaluated using the GaitRite system, at comfortable and fast speed, and with eyes closed. Neuropsychological assessment included Digit Span Backwards, Controlled Oral Word Association Test, Trail Making Test and Stroop Interference. Findings were statistically processed and compared with age and sex-matched healthy controls.

Results: Total NNIPPS-PPS score was low (9.8±SD10.7), signs of parkinsonism were present in only 7 patients, 6 had positive pull test. 19 patients admitted balance and gait difficulties with fear of falling according to FES (9.9±SD4.4). In comparison with controls, patients were slower in the TUG test (p<0.001), produced shorter steps with prolonged step time, had lower velocity, longer duration of double support phase (all p<0.001) and wider base of support (p=0.006). Executive deficit was proven in 11 patients, who had higher cadence in comfortable gait compared to patients with normal cognition. MRI of brain revealed lesions in basal ganglia in 16 patients and hemorrhagic necrosis was rarely seen in brainstem, cerebellum and subcortical white matter, however no significant correlation with gait parameters was observed.

Conclusions: Patients after methanol intoxication did not show parkinsonian gait, Instead, they presented slower wide-based gait with shortened steps and fear of falling, what corresponds with frontal gait disorder. Frontal type of impairment is also supported by proven executive deficit.

References: GAUK 758216

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MDS Abstracts - https://www.mdsabstracts.org/abstract/gait-and-balance-impairment-after-methanol-intoxication/