December 3, 2025

@michaelokun

What happens to gait and balance following STN DBS? A new randomized study just dropped. Spoiler alert: Parkinson's is a progressive disease, so even if walking and freezing improve, watch out for the inevitable progressive balance challenges. This study followed folks for 36 months w/ STN DBS. Subthalamic nucleus (STN) refers to a small deep brain structure that helps regulate movement signals passing through the basal ganglia. Szlufik and colleagues describe in a new paper in Biomedicines how bilateral STN DBS compareed w/ best medical therapy over 36 months for balance and gait symptoms in advanced Parkinson’s disease. Key Points: - Dynamic balance and gait tasks such as tandem pivot and tandem walking remained stable across all visits in the DBS cohort. - Progressive dynamic decline occurred in the best medical therapy group. The best medical therapy group showed a meaningful deterioration in tandem walking performance and dynamic postural control over time. - There were static balance limitations after DBS. Static balance under sensory-deprived conditions such as eyes closed and medication OFF worsened in the DBS group, highlighting a selective limitation that persisted over the three years. My take: So many people would love to have their walking and balance improved by DBS. A good rule of thumb is that DBS will have the potential to improve walking to the best on state, in some but not all people. Balance does not improve and may worsen, especially over time and with disease progression. Freezing may improve in about ~1/3. Here are 5 points that resonated w/ me: 1- Many folks maintained their ability to walk tandem and pivot over three years when treated w/ STN DBS. 2- Static balance challenges persisted. Even w/ DBS, 'standing still' in difficult sensory conditions remained vulnerable. 3- Therapy should be individualized and it is not a bad idea to pair DBS w/ targeted physical therapy. 4- Long term planning matters. 5- Proactive multidisciplinary support to help folks stay upright and move confidently is important, especially as the disease progresses. https://www.mdpi.com/2227-9059/13/11/2794 #parkinson #deepbrainstimulation #DBS #michaelokun #Fixelin