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. 2025 Jun 12.
doi: 10.1002/mdc3.70170. Online ahead of print.

Differential Effects of Levodopa and Stimulation on Post-Surgery Freezing of Gait in Subthalamic Nucleus Deep Brain Stimulation Parkinson's Disease Patients: A Clinical and Kinematic Analysis

Raquel Barbosa  1   2   3 , Paulo Bastos  1 , Patrícia Pita Lobo  4 , Catarina Correia Rodrigues  4 , Anabela Valadas  4   5 , Leonor Correia Guedes  4   5 , Beatriz Mano  6 , Sara Alberto  6 , Vitor Paixão  6 , Mário Miguel Rosa  4   5   7 , Ricardo Matias  6   8 , Daniel Martins  9 , Marcelo Mendonça  2   9 , Miguel Coelho  4   5
Affiliations

Differential Effects of Levodopa and Stimulation on Post-Surgery Freezing of Gait in Subthalamic Nucleus Deep Brain Stimulation Parkinson's Disease Patients: A Clinical and Kinematic Analysis

Raquel Barbosa et al. Mov Disord Clin Pract. .

Abstract

Background: The long-term efficacy of high-frequency subthalamic nucleus deep brain stimulation (STN-DBS) on freezing of gait (FOG) remains unclear. We aimed to study the mechanism and optimal therapeutic approach to long-term post-surgery FOG.

Objective: The aim was to assess the mechanism and optimal therapeutic approach to long-term post-surgery FOG.

Methods: Seventeen Parkinson's disease (PD) STN-DBS patients with a FOG score (item 3.11) ≥2 in the MedON/StimON condition were evaluated under 5 experimental conditions, including a low-frequency (60 Hz) condition maintaining the same total energy delivered. In each condition, gait and FOG episodes (#FOG) were assessed using clinical (eg, a 3 × 14-m Stand-Walk-Sit Test) and kinematic data from inertial measurement units (IMU).

Results: Compared to MedOFF/StimOFF, #FOG significantly decreased in the MedON/StimON 130-Hz condition. Either stimulation or levodopa (LD) (MedOFF/StimON or MedON/StimOFF) also significantly reduced #FOG and Stand-Walk-Sit Test (SWS) time compared to MedOFF/StimOFF. No significant difference in #FOG episodes or SWS time was found between 130 and 60 Hz, though 60-Hz stimulation had lower axial scores. Individual responses to LD or stimulation varied: (1) 3 patients improved #FOG with LD but worsened with stimulation, whereas 5 exhibited the reverse; (2) in 9 patients, low-frequency stimulation outperformed high-frequency stimulation in reducing #FOG. Gait variability was the strongest kinematic dimension associated with FOG, with severity accurately identified via a neural network trained on sensor data.

Conclusion: Post-DBS FOG in the best-functional state is largely therapy resistant, partially improved by stimulation and medication. Individual variability in responses to LD and stimulation underscores the need to determine FOG circuit mechanisms, as treatment remains an unmet clinical need.

Keywords: Parkinson's disease; deep brain stimulation; freezing of gait; gait analysis; inertial measurement units.

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