Deep brain stimulation in Parkinson's disease: Effects on gait and postural control

Ariel Tankus*, Jeffrey M. Hausdorff

*Corresponding author for this work

Research output: Chapter in Book/Report/Conference proceedingChapterpeer-review


Patients with Parkinson's disease (PD) commonly suffer from gait and postural disorders (Bloem et al., Mov Disord 19:871-84, 2004), often leading to falls and injuries (Segev-Jacubovski et al., Expert Rev Neurother 11:1057-75, 2011; Montero- Odasso et al., J Am Geriatr Soc 60:2127-36, 2012).When the symptoms of the disease become resistant to drugs, a routine neurosurgical treatment is implantation of electrodes for deep brain stimulation (DBS). Whereas DBS is most effective in alleviating the symptoms of tremor and rigidity, it has also been demonstrated to reduce gait variability, thus improving stability (Hausdorff et al., Mov Disord Off J Mov Disord Soc 24:1688-92, 2009).We therefore begin by reviewing the effect of DBS on gait and posturewhen electrodes are implanted in the most common targets: the subthalamic nucleus (STN) and the globus pallidus internum(GPi) and with the commonly used high frequency parameters (around 130 Hz), considering the possible mechanisms underlying its therapeutic effect, negative effects, and the deterioration in therapeutic effect over time. We continue by examining a recently suggested change of parameters, reduction of stimulation frequency to 60 or 80 Hz, in order to specifically treat gait impairment. Another phenomenon that has been addressed by DBS in recent year is freezing of gait, which is a particularly debilitating phenomenon experienced by a subpopulation of patients with PD. To alleviate freezing, the pedunculopontine nucleus (PPN) has been suggested as the target brain area. Mixed evidence as for the effectiveness of this treatment and the exact symptoms it affects imply that more studies are necessary in order to establish PPN DBS as a routine treatment. We conclude with a brief summary of open questions and work that should be addressed in future studies.

Original languageEnglish
Title of host publicationLocomotion and Posture in Older Adults
Subtitle of host publicationThe Role of Aging and Movement Disorders
PublisherSpringer International Publishing
Number of pages12
ISBN (Electronic)9783319489803
ISBN (Print)9783319489797
StatePublished - 7 Feb 2017


  • Basal ganglia
  • DBS
  • Deep brain stimulation
  • Gait
  • Neurosurgery
  • Parkinson's disease
  • Posture
  • Stability
  • Subthalamic nucleus
  • Walking


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