Deep brain stimulation (DBS) as a therapeutic approach in gait disorders: What does it bring to the table?

Abstract

Gait deficits are found in various degenerative central nervous system conditions, and are particularly a hallmark of Parkinson's disease (PD). While there is no cure for such neurodegenerative disorders, Levodopa is considered as the standard medication in PD patients. Often times, the therapy of severe PD consists of deep brain stimulation (DBS) of the subthalamic nucleus. Earlier research exploring the effect of gait have reported contradictory results or insufficient efficacy. A change in gait includes various parameters, such as step length, cadence, Double-stance phase duration which may be positively affected by DBS. DBS could also be effective in correcting the levodopa-induced postural sway abnormalities. Moreover, during normal walking, interaction among the subthalamic nucleus and cortex -essential regions which exert a role in locomotion- are coupled. However, during the freezing of gait, the activity is desynchronized. The mechanisms underlying DBS-induced neurobehavioral improvements in such scenarios requires further study. The present review discusses DBS in the context of gait, the benefits associated with DBS compared to standard pharmacotherapy options, and provides insights into future research.

Keywords: Deep brain stimulation; Gait disorder; Gait imbalance; Neurodegeneration; Neurosciences.

Fig. 1

Deep brain stimulation and brain structure. This figure shows the brain structure involved in Parkinson's disease, like globus pallidus, midbrain locomotor region, Laterodorsal tegmental nucleus, pedunculopontine tegmental nucleus, and subthalamic nucleus. Deep brain stimulation could stimulate these parts to improve symptoms of Parkinson's disease. Moreover, this figure shows neuroinflammation, neuron degeneration, and accumulation of α-synuclein and β-aggregates are histopathological features of Parkinson's disease. Created with BioRender.com.