The effects of deep brain stimulation on balance in Parkinson's disease as measured using posturography-a narrative review
File(s)
Published version
Author(s)
Lonergan, Bradley
Seemungal, Barry M
Ciocca, Matteo
Tai, Yen F
Type
Journal Article
Abstract
Background: Postural imbalance with falls affects 80% of patients with Parkinson’s disease (PD) at 10 years. Standard PD therapies (e.g., levodopa and/or deep brain stimulation—DBS) are poor at improving postural imbalance. Additionally, the mechanistic complexity of interpreting postural control is a major barrier to improving our understanding of treatment effects. In this paper, we review the effects of DBS on balance as measured using posturography. We also critically appraise the quantitative measures and analyses used in these studies. Methods: A literature search was performed independently by 2 researchers using the PUBMED database. Thirty-eight studies are included in this review, with DBS at the subthalamic nucleus (STN-) (n = 25), globus pallidus internus (GPi-) (n = 6), ventral intermediate nucleus (VIM)/thalamus (n = 2), and pedunculopontine nucleus (PPN) (n = 5). Results: STN- and GPi-DBS reduce static sway in PD and mitigate the increased sway from levodopa. STN-DBS impairs automatic responses to perturbations, whilst GPi-DBS has a more neutral effect. STN-DBS may promote protective strategies following external perturbations but does not improve adaptation. The evidence regarding the effects on gait initiation is less clear. Insufficient evidence exists to make conclusions regarding VIM- and PPN-DBS. Conclusions: STN- and GPi-DBS have differing effects on posturography, which suggests site-specific and possibly non-dopaminergic mechanisms. Posturography tests should be utilised to answer specific questions regarding the mechanisms of and effects on postural control following DBS. We recommend standardising posturography measures and test conditions by expert consensus and greater long-term data collection, utilising ongoing DBS registries.
Date Issued
2025-05-21
Date Acceptance
2025-05-19
Citation
Brain Sciences, 2025, 15 (5)
ISSN
2076-3425
Publisher
MDPI AG
Journal / Book Title
Brain Sciences
Volume
15
Issue
5
Copyright Statement
© 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/ licenses/by/4.0/).
License URL
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/40426705
PII: brainsci15050535
Subjects
balance
deep brain stimulation
GAIT INITIATION
IMPROVES
INSTABILITY
INTEGRATION
LEVODOPA
Life Sciences & Biomedicine
MECHANISMS
Neurosciences
Neurosciences & Neurology
Parkinson's disease
PEDUNCULOPONTINE NUCLEUS
POSTURAL CONTROL
postural instability
posturography
Science & Technology
STN-DBS
SUBTHALAMIC NUCLEUS STIMULATION
Publication Status
Published
Coverage Spatial
Switzerland
Article Number
535
Date Publish Online
2025-05-21