A systematic review of 20 studies has found that deep brain stimulation of the subthalamic nucleus (STN-DBS), a widely used treatment for Parkinson’s disease (PD), may lead to unexpected gait and balance worsening in some patients. While the procedure effectively reduces appendicular symptoms such as tremors and rigidity, researchers report that 15.9% of patients in controlled studies experienced gait deterioration compared to 5.8% receiving best medical treatment alone.
The study analyzed 1,010 patients from various trials, excluding cases with immediate postoperative complications or those beyond 12 months after surgery to rule out normal disease progression. Symptoms such as freezing of gait and falls most commonly appeared between 3 and 6 months post-surgery. Researchers noted that modulation of pedunculopontine afferents—neural pathways involved in gait control—was frequently associated with these complications.
These findings raise concerns about the multifactorial nature of post-STN-DBS gait and balance issues. While STN-DBS remains a critical tool in PD management, the study emphasizes the need for further research using gait labs and advanced imaging to better understand these complications and refine patient selection criteria.
Future studies must also establish a more accurate incidence rate, as some research may have underreported cases. Clinicians should remain vigilant in monitoring gait and balance changes in post-surgical PD patients to ensure optimal outcomes.
Reference: Janssen Daalen JM et al. Gait and balance worsening after bilateral deep brain stimulation of the subthalamic nucleus (STN-DBS) for Parkinson’s disease: a systematic review. BMJ Neurol Open. 2025;7:e000898.
Anaya Malik | AMJ
