Deep brain stimulation for freezing of gait in Parkinson's disease: An updated systematic review, meta-analysis, and a single-center clinical experience.

Clinical Snapshot

Key Findings

• P Value: Not reported for primary meta-analysis

• Effect Size: Modest improvement in freezing of gait symptoms

• Primary Outcome: FOG-Q score reduction of -2.99 points (95% CI: -5.69 to -0.29)

• Nnt Or Sensitivity: Greatest benefit in Med-OFF/Stim-ON state (MD -5.88; 95% CI -9.28 to -2.47)

• Confidence Interval: 95% CI crosses zero for some comparisons, indicating uncertainty

Clinical Application

Limited to specialized neurosurgical centers with DBS expertise; requires careful patient selection DBS is PBS-subsidized for PD in Australia; would require multidisciplinary assessment through movement disorder clinics and adherence to TGA-approved indications PD patients with treatment-resistant freezing of gait, particularly those with significant off-medication symptoms

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.

References

1. 1.Behboodi, M., Abdollahifard, S., Assadian, K., Golabi, F., Moshfeghinia, R., Dehkordi, P. K., Rezaei, R., Sabet, S., Razmkon, A., & Slavin, K. (2026). Deep brain stimulation for freezing of gait in Parkinson's disease: An updated systematic review, meta-analysis, and a single-center clinical experience. Neurosurgical Review. https://doi.org/10.1177/1877718X251359241