Troubleshooting Gait Problems in Parkinson's Disease Patients with Subthalamic Nucleus Deep Brain Stimulation

Subthalamic nucleus deep brain stimulation (STN DBS) is an established therapy for a subset of patients with Parkinson's disease, and the adjustment of DBS parameters is typically guided by the patients' rigidity and tremor. Although these cardinal symptoms remain relatively stable over time, progressive worsening of axial symptoms compromise motor function and quality of life. Because many patients report improvements in their global mobility after gait improvement, we have been adjusting DBS parameters during the long-term after surgery based on gait analysis. Here, we describe a practical strategy for troubleshooting gait problems in PD DBS patients by revising stimulation parameters through "hands-on" programming, which can be a useful alternative approach for improving patients' outcomes after STN DBS.