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Although levodopa and deep brain stimulation (DBS) of the subthalamic nucleus and the globus pallidus internus have been established therapies for addressing the motor symptoms of PD, their effects on gait are less predictable and not well sustained with disease progression. Given the high prevalence of gait impairment in PD and the limitations in currently approved therapies, there has been considerable interest in alternative neuromodulation targets and techniques. These have included DBS of pedunculopontine nucleus and substantia nigra pars reticulata, spinal cord stimulation, non-invasive modulation of cortical regions and, more recently, vagus nerve stimulation. However, successes and failures have also emerged with these approaches. Current gaps and controversies are related to patient selection, optimal electrode placement within the target, placebo effects and the optimal programming parameters. Additionally, recent advances in pathophysiology of oscillation dynamics have driven new models of closed-loop DBS systems that may or may not be applicable to gait issues. Our aim is to describe approaches, especially neuromodulation procedures, and emerging challenges to address PD gait issues beyond subthalamic nucleus and the globus pallidus internus stimulation.<\/jats:p>","DOI":"10.1038\/s41531-021-00276-6","type":"journal-article","created":{"date-parts":[[2022,1,11]],"date-time":"2022-01-11T06:02:51Z","timestamp":1641880971000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Gaps and roadmap of novel neuromodulation targets for treatment of gait in Parkinson\u2019s disease"],"prefix":"10.1038","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6305-3327","authenticated-orcid":false,"given":"Rubens Gisbert","family":"Cury","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola","family":"Pavese","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tipu Z.","family":"Aziz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0675-9064","authenticated-orcid":false,"given":"Joachim K.","family":"Krauss","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Moro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the Neuromodulation of Gait Study Group from Movement Disorders Society","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,1,11]]},"reference":[{"key":"276_CR1","doi-asserted-by":"publisher","first-page":"1229","DOI":"10.1080\/14737175.2019.1656067","volume":"19","author":"MLTM M\u00fcller","year":"2019","unstructured":"M\u00fcller, M. 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N.P. has participated in advisory boards (Britannia, Boston Scientific, Benevolent AI, Roche, Abbvie), has received honoraria from Britannia, Abbvie, GE Healthcare, Boston Scientific and grants from Independent Research Fund Denmark, Danish Parkinson\u2019s disease Association, Parkinson\u2019s UK, Center of Excellence in Neurodegeneration (CoEN) network award, GE Healthcare Grant, Multiple System Atrophy Trust, Weston Brain Institute, EU Joint Program Neurodegenerative Disease Research (JPND), EU Horizon 2020 research and innovation program, Italian Ministry of Health. T.A. has received travel grants from Medtronic, Abbott and Boston. J.K.K. is a consultant to Medtronic and Boston Scientific. E.M. has received honoraria from Medtronic and Abbott for consulting, and educational grant support from Boston and Newronika. She has also received research grant support from Ipsen.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"8"}}