Objective: In this systematic review, we provide an overview of an underrecognized, but common side effect related to deep brain stimulation of the subthalamic nucleus (STN-DBS) as applied in advanced Parkinson’s disease, namely gait problems in patients that did not have any preoperative gait disorder (new-onset gait problems, NOGP).

Background: Deep brain stimulation of the STN-DBS is increasingly used as treatment in medication-refractory advanced Parkinson’s disease (PD). Despite its advantages in improving many cardinal symptoms, a variety of side-effects induced by surgery or stimulation have been described, including axial symptoms such as gait problems.

Method: We systematically searched PubMed, EMBASE and the Cochrane Library for all studies reporting any NOGP after STN-DBS until February 2022. For every cohort, the percentage of patients with new-onset gait-related adverse events was calculated. Details on disease characteristics and assessed risk factors were summarized and compared using descriptive statistics. If possible, summary estimates of baseline or follow-up characteristics between NOGP patients and controls were compared using two-sample t-tests.

Results: 23 articles describing 1252 patients were selected, of whom 212 were reported to have new-onset gait problems (16.9%). Most studies did not report detailed characteristics of the NOGP subgroup. Freezing of gait, falls and decreased gait velocity were the most reported symptoms and first symptoms developed between 2.5-12 months after surgery. Across studies, mean age (p=0.35) and disease duration (p=0.60) did not differ significantly between NOGP and controls. In individual studies, electrode position, inadvertent co-stimulation of gait networks and levodopa-equivalent daily dose were additionally associated with NOGP.

Conclusion: We argue that NOGP is underreported, as gait problems may not be directly evident from standardized clinical testing, are not always specifically assessed and might be falsely attributed to disease progression. Specific gait assessment before and after STN-DBS is necessary to gain insight in the incidence and clinical phenotype of NOGP. Further research into the predictors of NOGP after STN-DBS is warranted for diligent preoperative patient counseling and for preventing side effects that significantly affect patients’ quality of life.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/new-onset-gait-problems-after-bilateral-stn-dbs-for-parkinsons-disease-a-systematic-review/