Systematic review of DBS for freezing of gait in Parkinson's disease
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Key Takeaway
Consider that DBS may improve freezing of gait in Parkinson's disease, primarily in the medication-OFF state.
This is a systematic review and meta-analysis of deep brain stimulation (DBS) for freezing of gait in patients with Parkinson's disease, pooling data from 905 patients. The primary outcome was the Freezing of Gait Questionnaire (FOG-Q), with secondary outcomes including the Unified Parkinson's Disease Rating Scale part III (UPDRS-III).
The meta-analysis found a modest decrease in FOG-Q scores with DBS, with a mean difference (MD) of -2.99 (95% CI = -5.69 to -0.29). The biggest improvement was seen in the medication-OFF, stimulation-ON state (MD = -5.88, 95% CI = -9.28 to -2.47), while effects were smaller in the medication-ON state (MD = -2.65, 95% CI = -4.99 to -0.32). No significant benefit was found when comparing medication-ON/stimulation-OFF to medication-OFF/stimulation-ON (MD = -0.70, 95% CI = -3.88 to 2.48). UPDRS-III showed substantial improvement in the medication-OFF state with stimulation (MD = -14.35, 95% CI = -17.39 to -11.32).
A small cohort within the review showed significant improvement on both FOG-Q (P = 0.034) and UPDRS-III (P = 0.022). The authors noted significant heterogeneity and limited data for alternative targets, with substantial variation persisting across studies.
Practice relevance suggests DBS improves freezing of gait primarily in the medication-OFF state, with greater effects using high-frequency stimulation and subthalamic nucleus targets. Safety data were not reported, and the certainty of evidence warrants cautious interpretation.
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View Original Abstract ↓
Freezing of gait is a disabling and treatment-resistant manifestation of Parkinson's disease (PD). The effectiveness of deep brain stimulation (DBS) for freezing of gait remains inconsistent across stimulation targets, frequencies, and medication states. We conducted a systematic review and meta-analysis following PRISMA guidelines to examine how DBS affects freezing of gait in patients with PD. We searched Medline, Scopus, Web of Science, and Cochrane up to September 28, 2025. For synthesis, we combined mean differences and 95% confidence intervals for the Freezing of Gait Questionnaire (FOG-Q) and the Unified Parkinson's Disease Rating Scale (UPDRS) part III across different medication and stimulation settings to calculate the final effect size. Thirty-one studies with 905 patients were included. Of these, 21 provided FOG-Q data, and all reported UPDRS-III results. DBS led to a modest decrease in FOG-Q scores (mean difference [MD] = - 2.99; 95% CI = - 5.69 to - 0.29). The biggest improvement in FOG was seen when stimulation was used while patients were off medication (Med-OFF/Stim-OFF vs. Med-OFF/Stim-ON: MD - 5.88; 95% CI - 9.28 to - 2.47). Stimulation during the medication-ON state had smaller effects (Med-ON/Stim-OFF vs. Med-ON/Stim-ON: MD - 2.65; 95% CI - 4.99 to - 0.32), and there was no significant benefit when comparing Med-ON/Stim-OFF to Med-OFF/Stim-ON (MD - 0.70; 95% CI - 3.88 to 2.48). UPDRS-III scores improved substantially in the medication-OFF state with stimulation (MD - 14.35; 95% CI - 17.39 to - 11.32). High-frequency stimulation targeting the subthalamic nucleus provided more consistent benefits, yet substantial variation persisted across studies. The results of our small cohort showed significant improvement in FOG-Q and UPDRS-III (P values = 0.034, 0.022, respectively). DBS improves freezing of gait primarily in the medication-OFF state, with greater effects observed using high-frequency stimulation and subthalamic nucleus targets. Significant heterogeneity and limited data for alternative targets warrant cautious interpretation and further controlled studies.
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